Non obstructive azoospermia, (NOA) is the most common cause of azoospermia. NOA is characterised by hypergonadotrophic hypogonadism, testicular failure, and impaired spermatogenesis. The recent development of surgical sperm retrieval techniques such as microsurgical testicular sperm extraction (mTESE) has, for the first time, allowed some men with NOA to father biological children. It is common practice for endocrine stimulation therapies such as gonadotrophins, selective oestrogen receptor modulators (SERMs) and aromatase inhibitors to be used prior to mTESE to increase intra-testicular testosterone synthesis with the aim of improving sperm retrieval rates; however, there is currently a paucity of data underpinning their safety and efficacy. We present two cases of men with NOA undergoing endocrine stimulation therapy and mTESE. We also discuss the current evidence and controversies associated with the use of hormonal stimulation therapy in couples affected by this severe form of male infertility.
The Journal of clinical endocrinology and metabolism. 2020 Aug 18 [Epub ahead of print]
Tharu Tharakan, Andrea Salonia, Giovanni Corona, Waljit Dhillo, Suks Minhas, Channa Jayasena
Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom., Division of Experimental Oncology/Unite of Urology, URI, IRCCS Ospedale, San Raffaele, Milan, Italy., Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy., Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, United Kingdom.