Single centre retrospective analysis of endocrine stimulation therapy prior to microsurgical testicular sperm extraction (mTESE) in men with hypogonadism and non-obstructive azoospermia (NOA)
BAUS ePoster online library. Naylor K. 06/23/21; 319046; p13-8
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Katy Naylor
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Introduction: This study evaluated the role of endocrine stimulation prior to mTESE in men with hypogonadism and NOA.
Materials & Methods: This is a retrospective study on mTESE with/without prior endocrine stimulation (clomiphene or human chorionic gonadotropin). Hypogonadism was defined as serum testosterone (T) level <12nmol/L. Demographic data, cause of testicular failure, duration and type of endocrine stimulation, pre/post-stimulation hormone levels, successful sperm retrieval rate (SRR), average Johnsen score and vials retrieved were recorded.
Results: 168 men underwent mTESE, of which 59 received endocrine stimulation therapy for NOA between 2015-2020. Men with hypogonadism were selected (71/168, 43%). 28/71 had Klinefelter syndrome, of which 40 received stimulation prior mTESE for a mean of 13.9±9.2 months. T significantly increased after stimulation (6.3±3.3nmol/L vs. 11.7±7.4nmol/L) with a mean T change (ΔT) of 5.7nmol/L (-5.5-23.3, N35). In the stimulated group, pre-operative T was significantly higher than the unstimulated (11.7±7.4nmol/L vs. 7.8±3.0nmol/L, p:0.007), however, with no significant difference in mTESE success rate (16/40 vs. 13/31 - 40% vs. 42%). Comparing successful vs. unsuccessful mTESE, higher T and lower FSH and LH correlated with successful SRR. In stimulated men, ΔT before and after stimulation correlated with SRR (AUC 0.701, SE: 0.089, p:0.043) with ΔT>3.5nmol/L significantly associated with success (p:0.041).
Conclusions: Our study shows significant improvement of serum T concentration following endocrine stimulation therapy in hypogonadal men. Overall, in hypogonadal men, hormonal stimulation didn't relate to higher success rate, however our data suggested positive correlation between ΔT before and after stimulation, and a successful mTESE.
Materials & Methods: This is a retrospective study on mTESE with/without prior endocrine stimulation (clomiphene or human chorionic gonadotropin). Hypogonadism was defined as serum testosterone (T) level <12nmol/L. Demographic data, cause of testicular failure, duration and type of endocrine stimulation, pre/post-stimulation hormone levels, successful sperm retrieval rate (SRR), average Johnsen score and vials retrieved were recorded.
Results: 168 men underwent mTESE, of which 59 received endocrine stimulation therapy for NOA between 2015-2020. Men with hypogonadism were selected (71/168, 43%). 28/71 had Klinefelter syndrome, of which 40 received stimulation prior mTESE for a mean of 13.9±9.2 months. T significantly increased after stimulation (6.3±3.3nmol/L vs. 11.7±7.4nmol/L) with a mean T change (ΔT) of 5.7nmol/L (-5.5-23.3, N35). In the stimulated group, pre-operative T was significantly higher than the unstimulated (11.7±7.4nmol/L vs. 7.8±3.0nmol/L, p:0.007), however, with no significant difference in mTESE success rate (16/40 vs. 13/31 - 40% vs. 42%). Comparing successful vs. unsuccessful mTESE, higher T and lower FSH and LH correlated with successful SRR. In stimulated men, ΔT before and after stimulation correlated with SRR (AUC 0.701, SE: 0.089, p:0.043) with ΔT>3.5nmol/L significantly associated with success (p:0.041).
Conclusions: Our study shows significant improvement of serum T concentration following endocrine stimulation therapy in hypogonadal men. Overall, in hypogonadal men, hormonal stimulation didn't relate to higher success rate, however our data suggested positive correlation between ΔT before and after stimulation, and a successful mTESE.
Introduction: This study evaluated the role of endocrine stimulation prior to mTESE in men with hypogonadism and NOA.
Materials & Methods: This is a retrospective study on mTESE with/without prior endocrine stimulation (clomiphene or human chorionic gonadotropin). Hypogonadism was defined as serum testosterone (T) level <12nmol/L. Demographic data, cause of testicular failure, duration and type of endocrine stimulation, pre/post-stimulation hormone levels, successful sperm retrieval rate (SRR), average Johnsen score and vials retrieved were recorded.
Results: 168 men underwent mTESE, of which 59 received endocrine stimulation therapy for NOA between 2015-2020. Men with hypogonadism were selected (71/168, 43%). 28/71 had Klinefelter syndrome, of which 40 received stimulation prior mTESE for a mean of 13.9±9.2 months. T significantly increased after stimulation (6.3±3.3nmol/L vs. 11.7±7.4nmol/L) with a mean T change (ΔT) of 5.7nmol/L (-5.5-23.3, N35). In the stimulated group, pre-operative T was significantly higher than the unstimulated (11.7±7.4nmol/L vs. 7.8±3.0nmol/L, p:0.007), however, with no significant difference in mTESE success rate (16/40 vs. 13/31 - 40% vs. 42%). Comparing successful vs. unsuccessful mTESE, higher T and lower FSH and LH correlated with successful SRR. In stimulated men, ΔT before and after stimulation correlated with SRR (AUC 0.701, SE: 0.089, p:0.043) with ΔT>3.5nmol/L significantly associated with success (p:0.041).
Conclusions: Our study shows significant improvement of serum T concentration following endocrine stimulation therapy in hypogonadal men. Overall, in hypogonadal men, hormonal stimulation didn't relate to higher success rate, however our data suggested positive correlation between ΔT before and after stimulation, and a successful mTESE.
Materials & Methods: This is a retrospective study on mTESE with/without prior endocrine stimulation (clomiphene or human chorionic gonadotropin). Hypogonadism was defined as serum testosterone (T) level <12nmol/L. Demographic data, cause of testicular failure, duration and type of endocrine stimulation, pre/post-stimulation hormone levels, successful sperm retrieval rate (SRR), average Johnsen score and vials retrieved were recorded.
Results: 168 men underwent mTESE, of which 59 received endocrine stimulation therapy for NOA between 2015-2020. Men with hypogonadism were selected (71/168, 43%). 28/71 had Klinefelter syndrome, of which 40 received stimulation prior mTESE for a mean of 13.9±9.2 months. T significantly increased after stimulation (6.3±3.3nmol/L vs. 11.7±7.4nmol/L) with a mean T change (ΔT) of 5.7nmol/L (-5.5-23.3, N35). In the stimulated group, pre-operative T was significantly higher than the unstimulated (11.7±7.4nmol/L vs. 7.8±3.0nmol/L, p:0.007), however, with no significant difference in mTESE success rate (16/40 vs. 13/31 - 40% vs. 42%). Comparing successful vs. unsuccessful mTESE, higher T and lower FSH and LH correlated with successful SRR. In stimulated men, ΔT before and after stimulation correlated with SRR (AUC 0.701, SE: 0.089, p:0.043) with ΔT>3.5nmol/L significantly associated with success (p:0.041).
Conclusions: Our study shows significant improvement of serum T concentration following endocrine stimulation therapy in hypogonadal men. Overall, in hypogonadal men, hormonal stimulation didn't relate to higher success rate, however our data suggested positive correlation between ΔT before and after stimulation, and a successful mTESE.
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