title: Salvage hormonal therapy after failed microdissection testicular sperm extraction: A multi-institutional prospective study.
abstract: To validate the efficacy of salvage hormonal therapy in men with non-obstructive azoospermia at their second microdissection testicular sperm extraction.
  
  
  
  This was a multi-institutional study registered at the Japanese University Hospital Medical Information Network clinical trial center. After 1 month of human chorionic gonadotropin therapy (5000 IU, three times a week), patients were treated with recombinant human follicle-stimulating hormone (150 IU, three times a week) and human chorionic gonadotropin for the next 3 months. Three testicular samples were obtained randomly from both testes, and sent for pathological diagnosis at the first and second microdissection testicular sperm extraction.
  
  
  
  A total of 21 men, excluding those with chromosomal abnormalities, azoospermia factor a or b deletions, extremely small testes (<2 mL), or prior hormonal therapy, were eligible to participate based on our inclusion criteria. At the first microdissection testicular sperm extraction, 13 and six patients had Sertoli cells only and an early maturation arrest, respectively. With the second microdissection testicular sperm extraction, sperm were successfully obtained from two patients (10%). Patient age, testicular volume and hormone profiles were not associated with the results of the second microdissection testicular sperm extraction. However, the testicular histology of the two successful patients were late maturation arrest and hypospermatogenesis.
  
  
  
  Effectiveness of human chorionic gonadotropin-based salvage hormonal therapy preceding a second microdissection testicular sperm extraction seems to be limited. Non-obstructive azoospermia men who have differentiated cells in their testes are likely to respond to hormonal stimulation.
authors.affiliation: Department of Urology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Shiraishi
authors.affiliation: Reproduction Clinic Osaka, Osaka, Japan.
authors.forename: Tomomoto
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Reproduction Center, Akasaka Sanno Hospital, Tokyo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Center for Infertility and IVF, International University of Health and Welfare Hospital, Nasushiobara, Japan.
authors.forename: Teruaki
authors.initials: T
authors.lastname: Iwamoto
authors.affiliation: Department of Urology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Matsuyama
mesh_terms: D053713:Azoospermia; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D042282:Microdissection; D011446:Prospective Studies; D012189:Retrospective Studies; D053625:Sperm Retrieval; D013094:Spermatozoa; D013737:Testis
chemical_list: D006063:Chorionic Gonadotropin
keywords: Leydig cells; hormonal therapy; human chorionic gonadotropin; microdissection testicular sperm extraction; non-obstructive azoospermia