MP31-07 THE EFFECT OF HORMONAL STIMULATION IN HYPOGONADAL MEN UNDERGOING MICROSURGICAL TESTICULAR SPERM RETRIEVAL (MTESE)

Abstract

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-07 THE EFFECT OF HORMONAL STIMULATION IN HYPOGONADAL MEN UNDERGOING MICROSURGICAL TESTICULAR SPERM RETRIEVAL (MTESE) Giovanni Chiriaco, Katy Naylor, Vikram Talaulikar, Elizabeth Williamson, Gerard Conway, David Ralph, and Philippa Sangster Giovanni ChiriacoGiovanni Chiriaco More articles by this author , Katy NaylorKaty Naylor More articles by this author , Vikram TalaulikarVikram Talaulikar More articles by this author , Elizabeth WilliamsonElizabeth Williamson More articles by this author , Gerard ConwayGerard Conway More articles by this author , David RalphDavid Ralph More articles by this author , and Philippa SangsterPhilippa Sangster More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Non obstructive azoospermia (NOA) is often associated with hypogonadism and testicular failure. This study aims to evaluate the role of endocrine stimulation therapy prior to mTESE in men with hypogonadism and NOA. METHODS: This is a retrospective study on infertile men who underwent mTESE with or without prior endocrine stimulation therapy (clomiphene or human chorionic gonadotropin). Hypogonadism was defined as serum testosterone (T) level <12 nm/L. We recorded cause of testicular failure, duration and type of hormonal stimulation, pre- and post-stimulation hormone levels (T, FSH, LH), pre-operative hormone levels, successful sperm retrieval rate, average Johnsen score and total number of vials of sperm retrieved. The success criteria for mTESE was defined as at least 1 vial of viable sperm retrieved. RESULTS: 168 men underwent mTESE out of which 59 men received stimulation therapy for NOA. Among them, we selected men with hypogonadism defined as serum T <12 nm/L (43% of the cohort). The hypogonadal group included 71 men - 28/71 had Klinefelter syndrome and 40/71 received endocrine stimulation prior to the procedure for a mean duration of 13.9±9.2 months. T levels significantly increased after endocrine stimulation (6.3±3.3 nm/L vs 11.7±7.4 nm/L) with mean change in serum T (ΔT) of 5.7 nm/L (-5.5–23.3, N35). In the stimulated group, pre-operative serum T levels were significantly higher (11.7±7.4 vs 7.8±3.0 p:0.007) as compared to unstimulated men but the success rate of mTESE did not differ significantly (16/40 vs 13/31 – 40% vs 42%). Men with Klinefelter syndrome demonstrated significant differences with regards to age, lower T levels, higher FSH and LH levels, lower Johnsen score and success rates compared to other causes of NOA. Comparing men who had successful mTESE vs unsuccessful mTESE - higher level of T and lower levels of FSH and LH seemed to correlate with successful sperm retrieval. Among men who received endocrine stimulation therapy the ΔT before and after stimulation seemed to correlate with successful mTESE (AUC: 0.701, SE: 0.089, p:0.043). In the stimulated group a ΔT>3.5 nm/L showed a significant association with successful mTESE (p:0.041). CONCLUSIONS: Our study shows that there is a significant improvement of serum T concentration following endocrine stimulation therapy in hypogonadal men with serum T<12 nm/L. Overall, in hypogonadal men, the hormonal stimulation seems not to be related to a higher success rate of mTESE but our data do suggest a positive correlation between ΔT before and after stimulation, and a successful mTESE. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e557-e557 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Chiriaco More articles by this author Katy Naylor More articles by this author Vikram Talaulikar More articles by this author Elizabeth Williamson More articles by this author Gerard Conway More articles by this author David Ralph More articles by this author Philippa Sangster More articles by this author Expand All Advertisement Loading ...