Bilateral Spermatic Vein Microligation and Human Chorionic Gonadotropin and Recombinant Folicle Stimulating Hormone Combination Therapy in Patient with Azoospermia

Abstract

Azoospermia, the absence of spermatozoa in ejaculate due to testicular failure or reproductive tract obstruction, is the most unfavorable form of male infertility and is found in approximately 15% of infertile men. We report a 34 years old man with primary infertility for 4 years due to azoospermia. There were bilateral varicoceles grade 2, low level of serum testosterone and luteinizing hormone and normal level of serum folicle stimulating hormone (FSH) on the low margin. The patient underwent sperm extraction (PESA and TESE method) with result there were no motile spermatozoa. On the spermatogenesis examination, it was revealed that the spermatogenesis process stopped on the spermatid phase. We decided to perform bilateral spermatic vein microligation followed by hormonal injection (HCG and FSH recombinant) for 4 months. On the evaluation, there was motile spematozoa on the left PESA. This finding suggested the effectiveness of the therapy, there was a spermatogenesis on this patient after bilateral spermatic vein microligation and combination hormonal therapy of HCG and FSH recombinant for 4 months. Keywords: primary infertility, azoospermia, HCG, recombinant FSH, spermatic vein microligation