The Turek Clinic, 9033 Wilshire Blvd, Suite 408, Beverly Hills, CA, 90211, USA.
College of Osteopathic Medicine, Touro University Nevada, Henderson, NV, USA.
J Assist Reprod Genet. 2022 Jun;39(6):1297-1303. doi: 10.1007/s10815-022-02497-x. Epub 2022 Apr 25.
To define the risk of hypogonadism following microdissection testicular sperm extraction in cases of non-obstructive azoospermia. While sperm retrieval by open testicular sperm extraction can be associated with an increased risk of hypogonadism, there is limited data addressing which procedures and which patients harbor the greatest risk.
We report on a community-acquired, nested, case-cohort of non-obstructive azoospermic patients referred to one clinic after failed bilateral microdissection testicular sperm extraction. Patients were health-matched (1:2) to surgically naïve controls and divided into 2 cohorts based on risk factors for hypogonadism. Among microdissection patients, we compared total testosterone and gonadotropin levels before and > 6 months after surgery. Biochemical hypogonadism was defined as a total serum testosterone level ≤ 300 ng/dL. Hormone levels were compared to risk-matched controls. Comparative statistics were used to assess hormone levels within and between cohorts.
There were no significant differences in baseline testosterone levels between microdissection patients (n = 26) and risk-matched controls (n = 52). At a mean of 26 months (range 6.2-112.8) post-procedure, mean testosterone levels decreased significantly (73 ng/dL or 16%; CI - 27, - 166; p < 0.01, paired t-test). Among microdissection patients with baseline testosterone > 300 ng/dL, 8/22 (36%) experienced hypogonadism post-procedure. There was a corresponding increase in follicle stimulating hormone (p = 0.05) and a trending increase in luteinizing hormones (p = 0.10).
A durable decrease in testosterone levels occurs after failed microdissection testicular sperm extraction regardless of baseline risk of hypogonadism. In addition, a significant proportion of eugonadal patients will become hypogonadal after failed testicular microdissection procedures.
定义非梗阻性无精子症患者行显微睾丸精子提取术后发生性腺功能减退症的风险。虽然开放式睾丸精子提取术取精可能会增加性腺功能减退症的风险，但关于哪种手术程序和哪种患者风险最大的数据有限。
我们报告了一项社区获得性、嵌套、病例对照研究，纳入了一家诊所就诊的因双侧显微睾丸精子提取术失败的非梗阻性无精子症患者。患者按健康情况（1:2）与未接受手术的对照者匹配，并根据性腺功能减退症的危险因素分为 2 个队列。在显微睾丸精子提取术患者中，我们比较了手术前后（>6 个月）的总睾酮和促性腺激素水平。生化性腺功能减退症定义为总血清睾酮水平≤300ng/dL。将激素水平与风险匹配的对照者进行比较。采用比较统计学方法评估队列内和队列间的激素水平。
显微睾丸精子提取术患者（n=26）与风险匹配的对照者（n=52）的基线睾酮水平无显著差异。术后平均 26 个月（范围 6.2-112.8）时，平均睾酮水平显著下降（73ng/dL 或 16%；CI-27，-166；p<0.01，配对 t 检验）。在基线睾酮>300ng/dL 的显微睾丸精子提取术患者中，8/22（36%）术后发生性腺功能减退症。卵泡刺激素相应增加（p=0.05），黄体生成素呈增加趋势（p=0.10）。
无论基线性腺功能减退症风险如何，失败的显微睾丸精子提取术后睾酮水平都会持续下降。此外，相当一部分生育能力正常的患者在失败的睾丸显微手术操作后会发生性腺功能减退症。
