Role of optimizing testosterone before microdissection testicular sperm extraction in men with nonobstructive azoospermia.
OBJECTIVE
Although optimizing endogenous testosterone production before testicular sperm extraction is commonly practiced, whether improved preoperative testosterone levels enhance sperm retrieval remains unclear. We evaluated the influence of preoperative medical therapy in men with nonobstructive azoospermia before microdissection testicular sperm extraction.


METHODS
A total of 1,054 men underwent microdissection testicular sperm extraction from 1999 to 2010. Patients with preoperative testosterone levels less than 300 ng/dl were treated with aromatase inhibitors, clomiphene citrate or human chorionic gonadotropin before microdissection testicular sperm extraction with the goal of optimizing testosterone levels. Patient demographics, preoperative testosterone levels, sperm retrieval rate and pregnancy outcomes were recorded and compared in men with different baseline testosterone levels.


RESULTS
Of the 736 men who had preoperative hormonal data 388 (53%) had baseline testosterone levels greater than 300 ng/dl. The sperm retrieval rate in these men was 56%. In the remaining 348 men with pretreatment testosterone levels less than 300 ng/dl, the sperm retrieval rate was similar (52%, p = 0.29). In addition, the sperm retrieval, clinical pregnancy and live birth rates were similar between men who responded to hormonal therapy and those who did not.


CONCLUSIONS
Men with nonobstructive azoospermia and hypogonadism often respond to hormonal therapy with an increase in testosterone levels, but neither baseline testosterone level nor response to hormonal therapy appears to affect overall sperm retrieval, clinical pregnancy or live birth rates.
Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA.
Jennifer E
JE
Reifsnyder
Ranjith
R
Ramasamy
Jad
J
Husseini
Peter N
PN
Schlegel
D047072:Aromatase Inhibitors / Q000008:administration & dosage; D053713:Azoospermia / Q000097:blood / Q000628:therapy*; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D002996:Clomiphene / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007248:Infertility, Male / Q000097:blood / Q000628:therapy*; D007713:Klinefelter Syndrome / Q000097:blood / Q000628:therapy; D008297:Male; D042282:Microdissection / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D053625:Sperm Retrieval; D013739:Testosterone / Q000097:blood*; D016896:Treatment Outcome
D047072:Aromatase Inhibitors; D006063:Chorionic Gonadotropin; D002996:Clomiphene; D013739:Testosterone