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

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          Abstract

          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.

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          Author and article information

          Contributors
          shirak@yamaguchi-u.ac.jp
          Journal
          Reprod Med Biol
          Reprod. Med. Biol
          10.1111/(ISSN)1447-0578
          RMB2
          Reproductive Medicine and Biology
          John Wiley and Sons Inc. (Hoboken )
          1445-5781
          1447-0578
          18 September 2014
          April 2015
          : 14
          : 2 ( doiID: 10.1111/rmb2.2015.14.issue-2 )
          : 65-72
          Affiliations
          [ 1 ] Department of Urology Yamaguchi University School of Medicine 755‐8505 Ube Yamaguchi Japan
          Author notes
          [* ] +81‐836‐22‐2275

          shirak@ 123456yamaguchi-u.ac.jp

          Article
          PMC5661759 PMC5661759 5661759 RMB20193
          10.1007/s12522-014-0193-1
          5661759
          29259404
          © The Japan Society for Reproductive Medicine
          Page count
          Figures: 2, Tables: 1, References: 59, Pages: 8, Words: 5486
          Categories
          Minireview
          Minireview
          Custom metadata
          2.0
          rmb20193
          April 2015
          Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.7 mode:remove_FC converted:04.12.2017

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