Spermatogenesis improved by suppressing the high level of endogenous gonadotropins in idiopathic non-obstructive azoospermia: a case control pilot study

Abstract

BackgroundElevated plasma gonadotropins were associated with desensitization of Sertoli and Leydig cells in the male testis. Testis spermatogenesis ability would be improved via inhibiting high endogenous gonadotropin in patients with severe oligozoospermia. Whether it would be beneficial for non-obstructive azoospermia (NOA) patients was still unclear.MethodsGoserelin, a gonadotropin releasing hormone agonist (GnRHα) was used to suppress endogenous gonadotropin levels (gonadotropin reset) in the NOA patients, improving the sensitization of the Sertoli and Leydig cells. Then human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) were injected to stimulate them to ameliorate the ability of testicular spermatogenesis. The main outcome measure was the existence of spermatozoa in the semen or by testicular sperm extraction (TESE). Elevation of inhibin B and/or ameliorative expression pattern of ZO-1 was the secondary objective.ResultsA total of 35 NOA men who failed to retrieve sperm via TESE were enrolled. Among these, 10 patients without treatment were selected as control group and secondary TESE was performed 6 months later. Of the 25 treated men, inhibin B was elevated in 11 patients in the first 4 weeks (Response group), while only 5 patients had constant increase in the following 20 weeks (Response group 2). Of the 5 men, 2 men acquired sperm (Response group 2B), while 3 failed (Response group 2A). Immunofluorescence of mouse vasa homologue (MVH) and ZO-1 showed that both positive MVH signals and ZO-1 expression were significantly increased in the Response group 2, but only Response group 2B showed ameliorative ZO-1 distribution.ConclusionsGonadotropin reset, a new therapeutic protocol with GnRHα, was able to improve the ability of testicular spermatogenesis in the NOA patients through restoring the sensitivity of Sertoli and Leydig cells, which were reflected by elevated inhibin B and ameliorative ZO-1 expression and distribution.Trial registrationClinicalTrials.gov identifier: NCT02544191.Electronic supplementary materialThe online version of this article (10.1186/s12958-018-0401-7) contains supplementary material, which is available to authorized users.

Microdissection testicular sperm extraction: preoperative patient optimization, surgical technique, and tissue processing

“…The subjects in this study were selected to have only hypospermatogenesis on histopathology. Only 2 of 25 had successful acquisition of sperm (13). These results were limited, the study had no comparator (untreated) control group, and the reported sperm retrieval was below that in previous published reports.…”

Evaluation of the potential role of shear wave elastography as a promising predictor of sperm retrieval in non‐obstructive azoospermic patients: A prospective study

“…19,20 TESE in combination with ICSI is a therapeutic technique for NOA men since mature testicular spermatozoa can be found in these men. 21 Many studies were done to define a predictor for sperm retrieval in cases with NOA such as testicular volume, FSH level, testicular blood flow, semen markers, and notably, histopathology which is considered the most important predictor of sperm retrieval. 22 SWE imaging on our participants' testes was performed by an expert radiologist in the longest longitudinal plane, and the measurements were recorded in terms of kPa and correlated with sperm retrieval in TESE.…”

“…[15][16][17] Previous studies found that SARS, 1 of the 3 epidemic coronaviruses to emerge in the past 20 years and that shows similar clinical presentations to COVID-19, 18 could cause orchitis 19 and focal testicular atrophy. 20 Considering the tens of millions of COVID-19 cases and that men are more vulnerable to COVID-19 than women, [21][22][23] it is imperative to determine the effect of COVID-19 on male reproduction. 24 Several studies have been performed on this topic.…”

Freeze-Dried Royal Jelly Proteins Enhanced the Testicular Development and Spermatogenesis in Pubescent Male Mice

“…The hypothalamic pituitary–gonadal (HPG) axis controlled by the central nervous system is the humoral component of an intercommunicating neural and endocrine system. Regulation of fertility is one of its most important functions [52]. Oral exposure to RJ, which has known with estrogenic activity in prepubertal and mature rodents and in the adult human [53,54].…”