title: Human chorionic gonadotrophin treatment prior to microdissection testicular sperm extraction in non-obstructive azoospermia.
abstract: BACKGROUND
  Despite the improved success rate of sperm retrieval by microdissection testicular sperm extraction (micro-TESE), methods to stimulate spermatogenesis in men with non-obstructive azoospermia (NOA) remain unexplored. The aim of this study was to evaluate the effects of hCG-based hormonal stimulation in men with NOA on the success of sperm retrieval by micro-TESE.
  
  
  METHODS
  Forty-eight men with NOA who had negative sperm retrieval results by the micro-TESE procedure were included. A second micro-TESE was subsequently performed on these men: 20 were not treated by any hormonal therapy, and 28 subjects received daily subcutaneous injections of hCG for 4-5 months prior to the second micro-TESE. Recombinant FSH was added if endogenous gonadotrophin levels decreased during the hCG stimulation. The sperm retrieval rate at the second micro-TESE; the levels of gonadotrophins, testosterone and estradiol; and the effects of hormonal therapy on testicular histology were evaluated.
  
  
  RESULTS
  Among the 28 men with hCG stimulation, 15 (54%) showed decreased LH and FSH levels (0.67 ± 0.10 and 0.96 ± 0.14 mIU, mean ± SEM, respectively) due to elevated serum testosterone (9.5 ng/dl). Sperm were obtained at the second micro-TESE from six men who had received hormonal therapy (21%), whereas no sperm were retrieved from untreated men (P < 0.05). Success at the second micro-TESE was more likely if histology at the first micro-TESE showed hypospermatogenesis.
  
  
  CONCLUSIONS
  The Leydig cells of the testis can respond positively to exogenous hCG even under hypergonadotropic conditions. HCG-based hormonal therapy prior to a second micro-TESE attempt is effective in men with hypospermatogenesis.
authors: Department of Urology, Yamaguchi University School of Medicine, 111 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan. shirak@yamaguchi-u.ac.jp
authors: Koji
authors: K
authors: Shiraishi
authors: Chietaka
authors: C
authors: Ohmi
authors: Tomoyuki
authors: T
authors: Shimabukuro
authors: Hideyasu
authors: H
authors: Matsuyama
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000097:blood / Q000473:pathology / Q000628:therapy*; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016903:Drug Monitoring; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004958:Estradiol / Q000097:blood; D043373:Follicle Stimulating Hormone, Human / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008499:Medical Records; D042282:Microdissection; D008875:Middle Aged; D011292:Premedication; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D053625:Sperm Retrieval; D013091:Spermatogenesis / Q000187:drug effects; D013737:Testis / Q000187:drug effects* / Q000473:pathology / Q000601:surgery*; D013739:Testosterone / Q000097:blood; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; D043373:Follicle Stimulating Hormone, Human; D011994:Recombinant Proteins; D013739:Testosterone; D004958:Estradiol; D007986:Luteinizing Hormone