Background:Hormonal treatment and response as a predictor of sperm retrieval prior to microdissection testicular sperm extraction(micro-TESE)are not well established in the current literature.This study aimed to inves...Background:Hormonal treatment and response as a predictor of sperm retrieval prior to microdissection testicular sperm extraction(micro-TESE)are not well established in the current literature.This study aimed to investigate the hormonal response as a predictor of sperm retrieval among men with nonobstructive azoospermia(NOA).Methods:Seventy-seven consecutive patients who had testosterone levels≤14 nmol/L were treated medically with an aromatase inhibitor or recombinant human chorionic gonadotropin(rec-hCG)prior to micro-TESE and were included.Thirty-four(44.2%)had unexplained NOA(UNEX),25(32.5%)had Klinefelter syndrome(KS),8(10.4%)had a history of cryptorchidism(UDT),4(5.2%)had microdeletion of the Azoospermia factor C(AZFc),and 6(7.8%)were treated previously with chemotherapy.Baseline and post-treatment serum hormonal levels were documented.Pre-op testosterone levels were entered into binary logistic regressions with age,Follicle-stimulating hormone(FSH),and Luteinizing hormone(LH)levels to test for significance with sperm retrieval.We then built logistic regression models to identify predictors of successful surgical sperm retrieval(SSR).Results:Forty-five patients(58%)had successful retrieval.In 32 patients(42%),no sperm was retrieved.Both the mean pre-op testosterone and the mean testosterone change between the two groups were significant(p=0.02 and p=0.011,respectively).Receiver operating characteristic(ROC)analysis demonstrated an area under the curve(AUC)of 0.785(95%CI=0.685-0.886,p<0.001).The Youden index coefficient was calculated for KS and UNEX.The cut-off point for KS was established at 0.764(sensitivity=0.875,false positive rate[FPR]=0.111),and 0.215 for UNEX(sensitivity=0.438,FPR=0.222).We also observed a correlation between age and SSR(p=0.05).In KS patients,SSR was determined by pre-op testosterone levels irrespective of age.Conclusion:Pre-operative hormonal response is a predictor for SSR in NOA patients who were treated medically.This data may help during pre-operative counselling.展开更多
文摘Background:Hormonal treatment and response as a predictor of sperm retrieval prior to microdissection testicular sperm extraction(micro-TESE)are not well established in the current literature.This study aimed to investigate the hormonal response as a predictor of sperm retrieval among men with nonobstructive azoospermia(NOA).Methods:Seventy-seven consecutive patients who had testosterone levels≤14 nmol/L were treated medically with an aromatase inhibitor or recombinant human chorionic gonadotropin(rec-hCG)prior to micro-TESE and were included.Thirty-four(44.2%)had unexplained NOA(UNEX),25(32.5%)had Klinefelter syndrome(KS),8(10.4%)had a history of cryptorchidism(UDT),4(5.2%)had microdeletion of the Azoospermia factor C(AZFc),and 6(7.8%)were treated previously with chemotherapy.Baseline and post-treatment serum hormonal levels were documented.Pre-op testosterone levels were entered into binary logistic regressions with age,Follicle-stimulating hormone(FSH),and Luteinizing hormone(LH)levels to test for significance with sperm retrieval.We then built logistic regression models to identify predictors of successful surgical sperm retrieval(SSR).Results:Forty-five patients(58%)had successful retrieval.In 32 patients(42%),no sperm was retrieved.Both the mean pre-op testosterone and the mean testosterone change between the two groups were significant(p=0.02 and p=0.011,respectively).Receiver operating characteristic(ROC)analysis demonstrated an area under the curve(AUC)of 0.785(95%CI=0.685-0.886,p<0.001).The Youden index coefficient was calculated for KS and UNEX.The cut-off point for KS was established at 0.764(sensitivity=0.875,false positive rate[FPR]=0.111),and 0.215 for UNEX(sensitivity=0.438,FPR=0.222).We also observed a correlation between age and SSR(p=0.05).In KS patients,SSR was determined by pre-op testosterone levels irrespective of age.Conclusion:Pre-operative hormonal response is a predictor for SSR in NOA patients who were treated medically.This data may help during pre-operative counselling.
