Short-Term Hormonal Changes Following Microdissection Testicular Sperm Extraction among Men with Non-Obstructive Azoospermia: Findings from a Large Longitudinal Prospective Multicentric Study

Purpose: We aimed to investigate possible hormonal changes following microdissection testicular sperm extraction (mTESE) in men with non-obstructive azoospermia (NOA) across three referral centers.

Materials and methods: We prospectively analyzed data from 102 consecutive NOA men. Patients with prior hormonal therapies were excluded. Preoperative serum hormone levels (total testosterone [tT], luteinizing hormone [LH], follicle-stimulating hormone [FSH], and 17β-estradiol) were collected, with repeat measurements at 3-month post-surgery. We divided the cohort into two groups using a tT cut-off value of 3 ng/mL: 1) men who kept eugonadal status; and, 2) men who were initially eugonadal but became testosterone deficient (TD) after surgery.

Results: Overall, median (interquartile range [IQR]) age was 37 years (32-40 years). Positive sperm retrieval during mTESE was observed in 34 (33.3%) patients, and 48 (47.1%) underwent bilateral mTESE. Compared to baseline, 3-month postoperative median (IQR) hormonal levels were as follows: tT: 3.71 ng/mL (2.76-5.24 ng/mL) vs. 4.27 ng/mL (3.25-6.07 ng/mL), p=0.32; FSH: 22.0 mIU/mL (12.65-31.47 mIU/mL) vs. 19.5 mIU/mL (11.63-25.8 mIU/mL), p=0.25; LH: 9.0 mIU/mL (5.11-12.4 mIU/mL) vs. 7.6 mIU/mL (5.04-13.4 mIU/mL), p=0.73, respectively. Twelve (13.5%) eugonadal men at baseline showed TD after mTESE. Median (IQR) tT values at baseline and 3-month follow-up were compared between those who preserved eugonadal status after surgery and those who became TD after surgery: baseline levels were 4.46 ng/mL (4.1-6.27 ng/mL) vs. 4.14 ng/mL (3.24-4.98 ng/mL), p=0.09; and, 3-month follow-up levels were 4.58 ng/mL (3.58-5.56 ng/mL) vs. 2.51 ng/mL (2.31-2.76 ng/mL), p<0.001, respectively. Men who developed TD had lower testicular volume (TV) (6 [4-10] vs. 10 [8-12.25] Prader, p=0.001) and karyotype abnormalities (4 [33.3] vs. 1 [1.3], p=0.006).

Conclusions: This multicentric study shows that mTESE in men with NOA does not significantly impact short-time postoperative follow-up tT, LH, and FSH levels. A substantial proportion of men who were initially eugonadal demonstrated tT suggestive for TD at 3-month follow-up. These men had lower TV at baseline and abnormal karyotype.