@Article{cju.2025.066936,
AUTHOR = {Shlomi Barak, Netanel Waldenberg, Aharon Peretz, Reut Bartoov, Guy Bar, Snir Dekalo},
TITLE = {Endocrine stimulation in men with non-obstructive azoospermia and low serum testosterone prior to micro-TESE: hormonal response as a predictor of sperm retrieval},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {33},
YEAR = {2026},
NUMBER = {1},
PAGES = {135--142},
URL = {http://www.techscience.com/CJU/v33n1/66436},
ISSN = {1488-5581},
ABSTRACT = { <b>Background:</b> 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). <b>Methods:</b> 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). <b>Results:</b> 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 &lt; 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. <b>Conclusion:</b> Pre-operative hormonal response is a predictor for SSR in NOA patients who were treated medically. This data may help during pre-operative counselling.},
DOI = {10.32604/cju.2025.066936}
}