TY - JOUR
T1 - Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia
T2 - Results of a World-Wide Survey, Guidelines and Expert Recommendations
AU - Global Andrology Forum
AU - Rambhatla, Amarnath
AU - Shah, Rupin
AU - Ziouziou, Imad
AU - Kothari, Priyank
AU - Salvio, Gianmaria
AU - Gul, Murat
AU - Hamoda, Taha
AU - Kavoussi, Parviz
AU - Atmoko, Widi
AU - Toprak, Tuncay
AU - Birowo, Ponco
AU - Ko, Edmund
AU - Arafa, Mohamed
AU - Ghayda, Ramy Abou
AU - Karthikeyan, Vilvapathy Senguttuvan
AU - Russo, Giorgio Ivan
AU - Pinggera, Germar Michael
AU - Chung, Eric
AU - Harraz, Ahmed M.
AU - Martinez, Marlon
AU - Phuoc, Nguyen Ho Vinh
AU - Tadros, Nicholas
AU - Saleh, Ramadan
AU - Savira, Missy
AU - Colpi, Giovanni M.
AU - Zohdy, Wael
AU - Pescatori, Edoardo
AU - Park, Hyun Jun
AU - Fukuhara, Shinichiro
AU - Tsujimura, Akira
AU - Rojas-Cruz, Cesar
AU - Marino, Angelo
AU - Mak, Siu King
AU - Amar, Edouard
AU - Ibrahim, Wael
AU - Sindhwani, Puneet
AU - Alhathal, Naif
AU - Busetto, Gian Maria
AU - Al Hashimi, Manaf
AU - El-Sakka, Ahmed
AU - Ramazan, Asci
AU - Dimitriadis, Fotios
AU - Timpano, Massimiliano
AU - Jezek, Davor
AU - Altay, Baris
AU - Zylbersztejn, Daniel Suslik
AU - Wong, Michael Y.C.
AU - Moon, Du Geon
AU - Soebadi, Mohammad Ayodhia
AU - Rizaldi, Fikri
N1 - Publisher Copyright:
Copyright © 2024 Korean Society for Sexual Medicine and Andrology.
PY - 2024
Y1 - 2024
N2 - Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.
AB - Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.
KW - Azoospermia
KW - Hypogonadism
KW - Infertility, male
KW - Semen
KW - Sperm retrieval
UR - http://www.scopus.com/inward/record.url?scp=85193998102&partnerID=8YFLogxK
U2 - 10.5534/WJMH.230339
DO - 10.5534/WJMH.230339
M3 - Article
AN - SCOPUS:85193998102
SN - 2287-4208
VL - 42
JO - World Journal of Men?s Health
JF - World Journal of Men?s Health
ER -