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Short-Term Hormonal Changes Following Microdissection Testicular Sperm Extraction among Men with Non-Obstructive Azoospermia: Findings from a Large Longitudinal Prospective Multicentric Study

Year: 2024

Type: article

Abstract: Purpose: Purpose: We aimed to investigate possible hormonal changes following microdissection testicular sperm extraction (mTESE) in men with non-obstructive azoospermia (NOA) across three referral centers.Materials and Methods: Materials and Methods: We prospectively analyzed data from 102 consecutive NOA men.Patients with prior hormonal therapies were excluded.Preoperative serum hormone levels (total testosterone [tT], luteinizing hormone [LH], follicle-stimulating hormone [FSH], and 17β-estradiol) were collected, with repeat measurements at 3-month post-surgery.We divided the cohort into two groups using a tT cut-off value of 3 ng/mL: 1) men who kept eugonadal status; and, 2) men who were initially eugonadal but became testosterone deficient (TD) after surgery.Results: Results: Overall, median (interquartile range [IQR]) age was 37 years (32-40 years).Positive sperm retrieval during mTESE was observed in 34 (33.3%)patients, and 48 (47.1%) underwent bilateral mTESE.Compared to baseline, 3-month postoperative median (IQR) hormonal levels were as follows: tT: 3.71 ng/mL (2.76-5.24ng/mL) vs. 4.27 ng/mL (3.25-6.07ng/mL), p=0.32;FSH: 22.0 mIU/mL (12.65-31.47mIU/mL) vs. 19.5 mIU/mL (11.63-25.8mIU/mL), p=0.25;LH: 9.0 mIU/mL (5.11-12.4mIU/mL) vs. 7.6 mIU/mL (5.04-13.4mIU/mL), p=0.73, respectively.Twelve (13.5%) eugonadal men at baseline showed TD after mTESE.Median (IQR) tT values at baseline and 3-month follow-up were compared between those who preserved eugonadal status after surgery and those who became TD after surgery: baseline levels were 4.46 ng/mL (4.1-6.27ng/mL) vs. 4.14 ng/mL (3.24-4.98 ng/mL), p=0.09; and, 3-month follow-up levels were 4.58 ng/mL (3.58-5.56ng/mL) vs. 2.51 ng/mL (2.31-2.76ng/mL), p<0.001, respectively.Men who developed TD had lower testicular volume (TV) (6 [4-10] vs. 10 [8-12.25]Prader, p=0.01) and karyotype abnormalities (4 [33.3] vs. 1 [1.3], p=0.006).Conclusions: Conclusions: This multicentric study shows that mTESE in men with NOA does not significantly impact short-time postoperative follow-up tT, LH, and FSH levels.A substantial proportion of men who were initially eugonadal demonstrated tT suggestive for TD at 3-month follow-up.These men had lower TV at baseline and abnormal karyotype.

Source: The World Journal of Men s Health

DOI: 10.5534/wjmh.240184