The Fertility Clinic Skive, Skive Regional Hospital, Denmark.
Departamento de Cirurgia, Divisão de Urologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil.
Int Braz J Urol. 2022 May-Jun;48(3):471-481. doi: 10.1590/S1677-5538.IBJU.2022.9913.
Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homologous sperm.
We report a series of eight NOA males who received long-term treatment with recombinant human chorionic gonadotropin twice a week for spermatogenesis stimulation. Six males received additional recombinant follicle-stimulating hormone (FSH) supplementation 150-225 IU twice weekly.
After recombinant gonadotropin therapy, viable spermatozoa were retrieved from the ejaculate in two patients and by testicular sperm aspiration (TESA) in another two subjects. Singleton spermatozoon retrieved from testes were frozen by vitrification on Cell-Sleeper devices. Two live births were obtained after intracytoplasmic sperm injection with ejaculated spermatozoa and one live birth and an ongoing pregnancy using thawed spermatozoa from TESA.
Our proof-of-concept study indicates that hormonal therapy with recombinant gonadotropins could be considered in infertile men with NOA as an alternative to sperm donation. Large-scale studies are needed to substantiate hormone stimulation therapy with recombinant gonadotropins in routine clinical practice for this severe form of male infertility.
与原发性生精失败相关的非梗阻性无精子症（NOA）是男性不育的常见原因，通常被认为是无法治疗的；然而，一些报告表明，通过激素刺激来提高睾丸内睾酮水平和生精作用，可能会增加使用同源精子实现妊娠的机会。
我们报告了一系列 8 例 NOA 男性，他们接受了重组人绒毛膜促性腺激素（rhCG）的长期治疗，每周两次以刺激生精作用。其中 6 名男性还接受了额外的重组卵泡刺激素（FSH）补充治疗，剂量为每周 2 次，150-225IU。
在重组促性腺激素治疗后，2 名患者的精液中可获取有活力的精子，另外 2 名患者可通过睾丸精子抽吸术（TESA）获取精子。使用 Cell-Sleeper 设备对从睾丸中获取的单个精子进行玻璃化冷冻。通过使用精液中的精子进行胞浆内单精子注射，获得了 2 例活产，通过解冻 TESA 中的精子，获得了 1 例活产和 1 例持续妊娠。
我们的概念验证研究表明，对于非梗阻性无精子症的不育男性，重组促性腺激素的激素治疗可以作为精子捐赠的替代方法。需要进行大规模研究，以证实重组促性腺激素激素刺激疗法在这种严重男性不育症的常规临床实践中的应用。
