Surgical treatment of nonobstructive azoospermy, caused by hypergonadotropic hypogonadism

Abstract

Objective. Determination of efficacy of intracytoplasmatic introduction of spermatozoid (ICSI) in treatment of infertile men, suffering hypergonadotropic hypogonadism, complicated by nonobstructive azoospermia (NОА), using technologies of TESE (еxtraction of spermatozoids), TESA (transcutaneous аspiration of sperm from testicle), аnd their combination (TESE and TESA) as well for the sperm cells extraction.
 Маterials and methods. The patients were divided into three Groups: Group 1 (TESE) – 31 patients, in whom the TESE procedure was applied for the sperm cells extraction from testicles; Group 2 (TESА) – 33 patients, in whom the TESА procedure was used for the sperm cells extraction; Group 3 (TESE and TESА) – 35 patients, in whom the combined TESА and TESE procedure was used for the sperm cells extraction. General duration of observation for the patients’ treatment efficacy in this Group have constituted 2 years.
 Results. The sperm cells extraction in accordance to the TESE procedure have secured successful extraction of spermatozoids in 8 (25.8%) of 31 patients Group 1. After the ICSI procedure application in 16.1% wives of these patients the fertilization have succeeded, got pregnant 12.9%, and gave birth 9.7%. The sperm cells extraction in accordance to the TESA procedure have secured successful extraction of sperm cells in 12 (36.4%) of 33 patients Group 2. After application of the ICSI procedure in 24.2% wives of these patients the fertilization have succeeded, have got pregnant 18.2%, and gave birth – 12.1%. The sperm cells extraction in accordance to the joint TESE and TESА procedure have secured successful extraction of spermatozoids in 16 (45.7%) of 35 patients Group 3. After application of the ICSI procedure in 34.3% wives of these patients the patients’ fertilization have succeeded, have got pregnant 28.5%, and gave birth – 20.0%.
 Conclusion. The combined procedure (TESE and TESA) proposed for infertile men with NОА, caused by hypergonadotropic hypogonadism, succeeds more often, and after this the indices of the ovum successful fertilization and the birthrate are higher, comparing with that after TESE or TESA procedures.