Abstract
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. This is a retrospective study on infertile men who underwent mTESE with or without prior endocrine stimulation therapy (clomiphene or hCG). Hypogonadism was defined as serum testosterone(T) level <12 nm/L. We recorded duration-type of stimulation, pre/post-stimulation hormone levels(T,FSH,LH) and successful sperm retrieval(SSR) rate. 168 men underwent mTESE out of which 59men received stimulation therapy. Among them, we selected men with hypogonadism (43% of the cohort). The hypogonadal group included 71 men; 28/71 had Klinefelter syndrome and 40/71 received endocrine stimulation for 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(∆T) 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 SSR 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 SSR 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 SSR. Among men who received stimulation therapy the ∆T 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>3.5nm/L showed a significant association with successful mTESE(p:0.041). Our study shows that there is a significant improvement of serum T concentration following endocrine stimulation therapy in hypogonadal men with serum T<12nm/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 ∆T before and after stimulation, and a successful mTESE. None
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