The number of spermatozoa collected with testicular sperm extraction is a novel predictor of intracytoplasmic sperm injection outcome in non-obstructive azoospermic patients

Cavallini, Giorgio; Magli, Maria Cristina; Crippa, Andor; Resta, Silvia; Vitali, Giuseppe; Ferraretti, Anna Pia; Gianaroli, Luca

doi:10.1038/aja.2010.166

Cited by 12 publications

(4 citation statements)

References 33 publications

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“…The latter is strongly influenced by even a minimal improvement in spermatogenesis. 15 AUTHOR CONTRIBUTIONS GC wrote the paper and studied two cases. Giovanni Beretta and Giulio Biagiotti studied one case each.…”

Section: Resultsmentioning

confidence: 99%

Preliminary study of letrozole use for improving spermatogenesis in non-obstructive azoospermia patients with normal serum FSH

Cavallini

Beretta²,

Biagiotti³

2011

Asian J Androl

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We investigated whether letrozole (2.5 mg day 21 ) improves sperm count in non-obstructive azoospermia (NOA) patients. Four men were included in this study, and they had folliculo-stimulating hormone and other hormone levels within the normal range and no varicoceles or chromosomal aberrations. These four patients were administered letrozole for 3 months. Sperm count, testicular volume, gonadotropin, testosterone (T) and estradiol (E2) blood levels were assessed before, during and 1 week after the suspension of treatment. All patients showed spermatozoa in their ejaculate, increased gonadotropin and T levels and lower E2 levels (P,0.05 in all cases), when letrozole was administered. This suggests that letrozole treatment might improve sperm count in an NOA sub-population; however, more studies, including the proper controls, are needed to confirm its efficacy. Asian Journal of Andrology (2011) 13, 895-897; doi:10.1038/aja.2011.44; published online 27 June 2011Keywords: letrozole; medical treatment; non-obstructive azoospermia; spermatogenesis INTRODUCTION Azoospermia indicates the absence of spermatozoa in the ejaculate after two assessments of centrifuged semen. Its prevalence is about 1% in the general population and 10%-15% in infertile couples. 1 Azoospermia is classified as obstructive (OA) or non-obstructive (NOA). NOA is defined by the clinical evidence of strongly affected spermatogenesis, and OA results from a seminal-tract obstruction. Men with OA typically have normal-sized testes, possible epididymal fullness and normal serum follicle-stimulating hormone (FSH) levels. Men with NOA present frequently with small testes and an elevated FSH level; however, a minority of these men have normal testicles and FSH levels within the normal range. 2 Only men with hypogonadotropic-hypogonadism NOA or varicocele-associated NOA may yield spermatozoa in their ejaculate after treatment; however, the majority of men with NOA and normal or elevated FSH levels are only able to father children after surgical retrieval of the spermatozoa from the testicles, which is performed by testicular sperm extraction (TESE) or with fine-needle aspiration (FNA). TESE and FNA yield spermatozoa in 30%-60% of cases depending on the technique used. 1 Patry et al. 3 recently reported one case of hypospermatogenesis (having FSH levels within the normal range), which was converted to active spermatogenesis after letrozole (Femara; Sanofi-Novartis, Paris, France) use. However, the patient remained azoospermic due to an obstruction in the epididymis that was not adequately assessed when surgery was performed. Saylam et al. 4 recently treated 17 NOA patients who had low (,10) testosterone (T)/estradiol (E2) ratios with letrozole. Four of these men showed spermatozoa in their ejaculate after 6 months of therapy.

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Section: Resultsmentioning

confidence: 99%

Preliminary study of letrozole use for improving spermatogenesis in non-obstructive azoospermia patients with normal serum FSH

Cavallini

Beretta²,

Biagiotti³

2011

Asian J Androl

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“…Whitcomb et al (35) pointed out that male age, after being adjusted for female-partner age, was nonsignificantly associated with likelihood of live birth. Cavallini et al (36) reported a detrimental effect of the retrieved-sperm count on the outcome of ICSI. In this context, maternal age in our study was a nonsignificant variable, owing primarily to the fact that most female partners were aged <30 years.…”

Section: Discussionmentioning

confidence: 98%

Relationship of paternal age with outcome of percutaneous epididymal sperm aspiration–intracytoplasmic sperm injection, in cases of congenital bilateral absence of the vas deferens

Elhanbly

Elsaied

Fawzy

et al. 2015

Fertility and Sterility

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“…The impact of an increased sperm count on the success of assisted reproduction techniques occurring after letrozole administration will be presented in a future study; however, because the quality of spermatogenesis in NOA patients is linked to intracytoplasmic sperm injection pregnancy rates, even mild improvement can improve the likelihood of pregnancy. 28 This might be particularly interesting for Italians since their law limits the efficiency of assisted reproduction treatment in couples with a severe male factor. 29,30 It is unlikely that letrozole increased congenital malformations, as no malformed babies were fathered during the course of letrozole treatment.…”

Section: Letrozole For Azoospermia and Cryptozoospermia G Cavallini Ementioning

confidence: 99%

Multivariate analysis to predict letrozole efficacy in improving sperm count of non-obstructive azoospermic and cryptozoospermic patients: a pilot study

Cavallini¹,

Biagiotti²,

Bolzon³

2013

Asian J Androl

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We tested the hypothesis that letrozole increases sperm count in non-obstructive azoospermic or cryptozoospermic patients with a testosterone (T)/17-beta-2-oestradiol (E2) ratio ,10. Forty-six patients with no chromosomal aberrations were randomized into two groups: 22 received letrozole 2.5 mg per day for 6 months (Group 1: 6 azoospermic116 cryptozoospermic patients), while 24 received a placebo (Group 2: 5 azoospermic119 cryptozoospermic patients). The following data were collected: two semen analyses, clinical history, scrotal Duplex scans, body mass index (BMI), Y microdeletion, karyotype and cystic fibrosis screens and follicle-stimulating hormone (FSH), luteinizing hormone (LH), E2, T and prolactin levels. Both before and after letrozole or placebo administration, the patients underwent two semen analyses and hormonal assessments. The differences were evaluated using the Mann-Whitney U test. The relationships between sperm concentration after letrozole administration with respect to FSH, T/E2 ratio, bilateral testicle volume and BMI before letrozole administration were assessed using multivariate analysis. The side effects were assessed using the chi-square test. Group 1 had sperm concentration (medians: 400-1.290310 6 ml 21 ; P,0.01) and motility (medians: class A from 2% to 15%; P,0.01), FSH, LH and T significantly increased, while Group 2 did not. E2 levels diminished significantly in Group 1, but not in Group 2. Eight patients in Group 1 demonstrated side effects, whereas no patient side effects were observed in Group 2. The sperm concentration after letrozole administration is inversely related to T/E2, FSH and BMI; a direct relationship emerged between sperm concentration and testicular volume.

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The number of spermatozoa collected with testicular sperm extraction is a novel predictor of intracytoplasmic sperm injection outcome in non-obstructive azoospermic patients

Cited by 12 publications

References 33 publications

Preliminary study of letrozole use for improving spermatogenesis in non-obstructive azoospermia patients with normal serum FSH

Preliminary study of letrozole use for improving spermatogenesis in non-obstructive azoospermia patients with normal serum FSH

Relationship of paternal age with outcome of percutaneous epididymal sperm aspiration–intracytoplasmic sperm injection, in cases of congenital bilateral absence of the vas deferens

Multivariate analysis to predict letrozole efficacy in improving sperm count of non-obstructive azoospermic and cryptozoospermic patients: a pilot study

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