Pharmacological treatment of non-obstructive azoospermia (NOA) makes sperm available for more patients compared to immediate sperm extraction

Abstract

This study assessed whether endocrine treatment increases the rate of obtaining sperm by ejaculation or surgical retrieval in patients with NOA. Prospective, non-randomized, controlled study. 612 NOA patients were included. 116 patients chose immediate microsurgical sperm extraction (micro-TESE) and served as the control group. 496 remaining patients were administered clomiphene and were classified and treated based on their response to medication. Patients with an increase in follicle stimulating hormone (FSH) and testosterone continued clomiphene treatment and were the primary study group. For patients with increased FSH and diminishing or no increase in luteinizing hormone (LH) and testosterone, human chorionic gonadotropin (hCG) was added. For patients with no increase in testosterone, LH or FSH, or with decreasing testosterone, clomiphene was replaced by hCG and hMG. After 9 monthly semen analyses, micro-TESE was performed for those who remained azoospermic. Success rates were compared to the control group using the chi-squared test. With medical treatment, 10.9% of patients developed sperm in their semen. Treated patients, who remained azoospermic underwent micro-TESE with a 57% success rate. In total, sperm was made available for 61.7% of medically treated patients compared to 33.6% in the control group (P<0.001), and each treatment group showed a significantly increased rate of sperm retrieval compared to the control group (maximum P=0.01). For NOA patients, a course of medical treatment may result in sperm in the ejaculate and increases the likelihood of successful micro-TESE for those remaining azoospermic.