MP43-07 DOES IMPLEMENTING A NEW PROTOCOL FOR HORMONAL INDUCTION OF SPERMATOGENESIS RESULT IN IMPROVED SPERM RETRIEVAL IN KLINEFELTER PATIENTS?

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP43-07 DOES IMPLEMENTING A NEW PROTOCOL FOR HORMONAL INDUCTION OF SPERMATOGENESIS RESULT IN IMPROVED SPERM RETRIEVAL IN KLINEFELTER PATIENTS? Giovanni Chiriaco, Katy Naylor, Aysha Uddin, Gerard Conway, Elizabeth Williamson, Umasuthan Srirangalingam, David Ralph, and Philippa Sangster Giovanni ChiriacoGiovanni Chiriaco More articles by this author , Katy NaylorKaty Naylor More articles by this author , Aysha UddinAysha Uddin More articles by this author , Gerard ConwayGerard Conway More articles by this author , Elizabeth WilliamsonElizabeth Williamson More articles by this author , Umasuthan SrirangalingamUmasuthan Srirangalingam 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.0000000000003289.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Klinefelter(KF) men commonly exhibit non obstructive azoospermia and hypogonadism. This study aims to evaluate if sperm retrieval rate(SSR) could be improved by implementing a new protocol of HCG treatment prior to mTESE. METHODS: KF men prospectively added to our database were compared to a previous retrospective group who had not undergone hormonal stimulation. Demographic data, previous testosterone therapy, duration of endocrine stimulation, pre-/ post-stimulation levels (T, FSH, LH), successful SSR, Johnsen score and total number of vials of sperm retrieved. Men started on 2000units of HCG twice/week and the dosage altered depending on response. Stimulation continued for a minimum of 6 months. Success criteria for mTESE was defined as at least 1 vial of viable sperm retrieved. RESULTS: Sixty-four KF men underwent mTESE, out of which 39 men received stimulation therapy for a mean duration of 11.8±8.5 month. No significant differences regarding mean age, Johnsen score and successful sperm retrieval (SSR) rate were detected between the 2 groups. The mean pre-stimulation serum testosterone level was 6.1±3.7 nm/L and it increased to 9.4±6.9nm/L post stimulation. We demonstrated that serum testosterone levels significantly increased after endocrine stimulation (6.1 ± 3.7 nm/L vs 9.8 ± 6.9 nm/L, p<0.001) with a mean change in serum testosterone (ΔT) of 4.9 nm/L. Baseline serum T level in the unstimulated group(10.5±4.9 nm/L) was significantly different to the baseline T of the stimulated group (p=0.001). The endocrine stimulation removed the significant difference between baseline serum T level in the stimulated group (9.8 versus 10.5 nmol/l). This may explain why SSR rates were ultimately the same. The SSR was 28% (17/39 in the stimulated group and 7/25 (28%) in the unstimulated group. Comparing both sets of men who had successful vs unsuccessful mTESE – a higher level of serum T correlated with a successful sperm retrieval (p=0.036). CONCLUSIONS: Our study shows that there is a significant improvement of serum T concentration following endocrine stimulation therapy in KF men and that a higher level of serum T correlates with successful SSR. We did not demonstrate that stimulation increases the chance of success when compared to non-stimulated men but this is likely to be due to a significant difference in baseline serum T between the 2 groups. The induction protocol of twice weekly HCG injections for 6 months was acceptable to patients and no major side effects experienced. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e603 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Chiriaco More articles by this author Katy Naylor More articles by this author Aysha Uddin More articles by this author Gerard Conway More articles by this author Elizabeth Williamson More articles by this author Umasuthan Srirangalingam More articles by this author David Ralph More articles by this author Philippa Sangster More articles by this author Expand All Advertisement PDF downloadLoading ...