Rescue of spermatogenesis arrest in azoospermic men after long-term gonadotropin treatment

Selman, Helmy; Santo, M. De; Sterzik, K.; Cipollone, Giuseppe; Aragona, Cesare; El-Danasouri, Imam

doi:10.1016/j.fertnstert.2005.12.055

Cited by 35 publications

(31 citation statements)

References 17 publications

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“…Selman et al evaluated a more selective group of men with normal baseline hormone profiles, testicular volumes, and a genetic analysis resulting in the first histological pattern of MA. Among the 49 patients examined, 11 (22.4 %) had sperm in their ejaculate by the second TESE following the FSH treatment [85].…”

Section: Hormonal Therapy Before or After Tesementioning

confidence: 99%

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The development of surgical sperm extraction and new challenges to improve the outcome

Enatsu

Chiba

Fujisawa

2015

Reprod Medicine & Biology

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Surgical sperm extraction with intracytoplasmic sperm injection has become widespread worldwide and is regarded as the sole option for patients with azoospermia. However, the sperm retrieval rate remains unsatisfactorily low, particularly for men with non-obstructive azoospermia (NOA). Therefore, the technical challenges associated with improving the sperm retrieval rate for men with NOA are being addressed. The most successful method developed to date is microdissection testicular sperm extraction (micro-TESE), which is rapidly becoming recognized as a useful technique due to its relatively high sperm retrieval rate and low complication rate. However, even with micro-TESE, the sperm retrieval rate for men with NOA remains at 30-60 %, with an even lower birth rate. The technical challenges associated with improving the outcomes of surgical sperm extraction are being approached through the use of ultrasound and optimal surgical devices such as narrow band imaging, multiphoton microscopy, and optical coherent tomography. In addition to the difficulties related to searching for sperm, medical treatments that induce spermatogenesis remain controversial. For example, varicocele repair prior to surgical sperm extraction and hormonal therapy before and after TESE have been extensively examined. We herein briefly summarized the development process in surgical sperm extraction up to the present and technical challenges to improve the outcomes of surgical sperm extraction.

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Section: Hormonal Therapy Before or After Tesementioning

confidence: 99%

“…Difficulties associated with these treatments include the low success rate of sperm retrieval and even lower pregnancy rate [85], as well as treatment costs. Larger studies are needed in order to identify appropriate candidates for hormonal therapy and the optimal doses of medication used.…”

Section: Hormonal Therapy Before or After Tesementioning

confidence: 99%

The development of surgical sperm extraction and new challenges to improve the outcome

Enatsu

Chiba

Fujisawa

2015

Reprod Medicine & Biology

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“…However, the second TESE was successful in 21% of men who received hormonal therapy, while it failed in all those who did not. By evaluating a more select group of men with normal baseline hormone profiles, testicular volumes and genetic analyses, Selman et al treated 49 men with rFSH, which was initially at 75 IU on alternate days for two months, followed by 150 IU for two months and then an additional 2,000 IU of hCG for two months (31). All men remained azoospermic at the end of treatment; however, while none had mature sperm in the pre-treatment testis biopsy, sperm were found in the biopsies of 22% men after treatment.…”

Section: Hypergonadotropic Hypogonadism/eugonadismmentioning

confidence: 99%

Medical management of non-obstructive azoospermia

Kumar¹

2013

Clinics

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Non-obstructive azoospermia is diagnosed in approximately 10% of infertile men. It represents a failure of spermatogenesis within the testis and, from a management standpoint, is due to either a lack of appropriate stimulation by gonadotropins or an intrinsic testicular impairment. The former category of patients has hypogonadotropic hypogonadism and benefits from specific hormonal therapy. These men show a remarkable recovery of spermatogenic function with exogenously administered gonadotropins or gonadotropin-releasing hormone. This category of patients also includes some individuals whose spermatogenic potential has been suppressed by excess androgens or steroids, and they also benefit from medical management. The other, larger category of non-obstructive azoospermia consists of men with an intrinsic testicular impairment where empirical medical therapy yields little benefit. The primary role of medical management in these men is to improve the quantity and quality of sperm retrieved from their testis for in vitro fertilization. Gonadotropins and aromatase inhibitors show promise in achieving this end point.

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“…Follicle-stimulating hormone (FSH) plays an important role in the initiation and maintenance of spermatogenesis [Nieschlag et al 1999]. Recombinant human FSH (rhFSH) has been used in the treatment of male infertility and several studies have reported successful results in separate patient groups with limited numbers of patients, including those with hypogonadotropic hypogonadism, oligozoospermia, idiopathic infertility, and maturation arrest [Selman et al 2006]. Another study reported that men with maturation arrest on testicular biopsy had spermatozoa in the ejaculate after rhFSH treatment [Efesoy et al 2009].…”

Section: Introductionmentioning

confidence: 99%

Induction of spermatogenesis by rhFSH for azoospermia due to spermatogenic dysfunction with maturation arrest: five case series

Kobori

Suzuki

Iwahata

et al. 2015

Systems Biology in Reproductive Medicine

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(2015) Induction of spermatogenesis by rhFSH for azoospermia due to spermatogenic dysfunction with maturation arrest: five case series, Systems Biology in Reproductive Medicine, 61:3, 168-170, DOI: 10.3109/19396368.2015 AbstractWhen sperm cannot be retrieved from the testes of patients with azoospermia due to spermatogenic dysfunction (ASD), there is no rational way for the patient to become a biological father. We investigated the possibility of inducing spermatogenesis in such patients by hormonal therapy with recombinant human follicle-stimulating hormone (rhFSH) alone. Twenty-six ASD patients who could not obtain spermatozoa by microdissection testicular sperm extraction (micro-TESE) were confirmed to have arrested spermatogenesis at the late stage of maturation arrest. They were subsequently treated with 75-150 IU two times/week rhFSH alone for 12 months. The primary endpoint was the appearance of sperm in ejaculate, and we followed the patients to determine the outcome of inseminating their partners. After rhFSH treatment, mature spermatozoa were found in the ejaculate in five of 26 (19.2%) patients, all of whom showed histology of non-uniform type maturation arrest. Intracytoplasmic sperm injection of the mature spermatozoa resulted in two ongoing clinical pregnancies (insemination success rate, 40.0%). Recombinant human follicle-stimulating hormone treatment can be used as an advanced assisted reproductive technology to improve spermatogenesis in some azoospermic patients with maturation arrest of spermatogenesis and is a potential treatment option after unsuccessful micro-TESE.

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Rescue of spermatogenesis arrest in azoospermic men after long-term gonadotropin treatment

Cited by 35 publications

References 17 publications

The development of surgical sperm extraction and new challenges to improve the outcome

The development of surgical sperm extraction and new challenges to improve the outcome

Medical management of non-obstructive azoospermia

Induction of spermatogenesis by rhFSH for azoospermia due to spermatogenic dysfunction with maturation arrest: five case series

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