Does Micro-TESE result in hypogonadism?

Wardak S1, Assiri H1, Yap T2, Ralph D1, Shabbir M2, Sangster P1
1University College London Hospitals, United Kingdom, 2Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

Objective: To evaluate whether surgical sperm retrieval in the form of Micro-TESE results in hypogonadism.

Methods:
A retrospective review of all Micro-TESE cases performed over a 3-year period at 2 large fertility centres was undertaken. A total of 340 patients were identified from prospectively maintained databases. Pre and post-operative testosterone level, time of testosterone measurement and time since Micro-TESE were collated. Low testosterone was defined as <8 nmol/L on an early morning fasted sample. Patients with a normal pre-operative and low post-operative testosterone level were identified.

Results:
From the total of 340 patients, 59 were excluded as they were on hormonal therapy. Of the remaining 281 patients, 177 were excluded due to incomplete follow up data. The remaining 104 patients with a median age of 34 years (range 25 – 53 years) were included in the analysis. Four out of 104 (3.8%) patients with normal pre Micro-TESE testosterone were found to have a low post-procedure early morning testosterone of <8 nmol/L.

Conclusions:
There is no consensus on when to check testosterone level post Micro-TESE. Variable practice was observed in both centres with no routine post-procedure testosterone levels in 63% of cases across both centres. In unselected patients who were tested, the rate of de novo hypogonadism at 3 months was low (3.8%). Micro-TESE is safe and remains the gold standard surgical sperm retrieval method for non-obstructive azoospermia. Considering the small but important risk of de novo hypogonadism, testosterone level post Micro-TESE should be checked in all patients.