Hormonal therapy for non-obstructive azoospermia: basic and clinical perspectives

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• 作者：Koji Shiraishi (1)
  
  1. Department of Urology ; Yamaguchi University School of Medicine ; Ube ; Yamaguchi ; 755-8505 ; Japan
  
• 关键词：Gonadotropins ; Hormonal therapy ; Intratesticular testosterone ; Non ; obstructive azoospermia ; Testicular sperm extraction
• 刊名：Reproductive Medicine and Biology
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：14
• 期：2
• 页码：65-72
• 全文大小：283 KB
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• 刊物主题：Reproductive Medicine; Gynecology; Urology/Andrology;
• 出版者：Springer Japan
• ISSN：1447-0578

文摘

Microdissection testicular sperm extraction (micro-TESE) combined with intracytoplasmic sperm injection is a standard therapeutic option for patients with non-obstructive azoospermia (NOA). Hormonal treatment has been believed to be ineffective for NOA because of high gonadotropin levels; however, several studies have stimulated spermatogenesis before or after micro-TESE by using anti-estrogens, aromatase inhibitors, and gonadotropins. These results remain controversial; however, it is obvious that some of the patients showed a distinct improvement in sperm retrieval by micro-TESE, and sperm was observed in the ejaculates of a small number of NOA patients. One potential way to improve spermatogenesis is by optimizing the intratesticular testosterone (ITT) levels. ITT has been shown to be increased after hCG-based hormonal therapy. The androgen receptor that is located on Sertoli cells plays a major role in spermatogenesis, and other hormonal and non-hormonal factors may also be involved. Before establishing a new hormonal treatment protocol to stimulate spermatogenesis in NOA patients, further basic investigations regarding the pathophysiology of spermatogenic impairment are needed. Gaining a better understanding of this issue will allow us to tailor a specific treatment for each patient.