Testicular sperm retrieval and intracytoplasmic sperm injection outcomes in hypogonadotropic hypogonadal men who remained azoospermic after gonadotropin therapy

Extracción de espermatozoides testiculares y resultados de la inyección intracitoplasmática de espermatozoides en hombres con hipogonadismo hipogonadotrófico que permanecieron azospérmicos después de la terapia con gonadotropinas

Background: Limited data exist regarding the sperm retrieval rate through testicular sperm extraction (TESE) in hypogonadotropic hypogonadal azoospermic men, as well as the fertilization and pregnancy outcomes associated with intracytoplasmic sperm injection (ICSI) using sperm retrieved. The objective of this study was to evaluate sperm retrieval rates through microscopic TESE and to analyze the outcomes of ICSI in hypogonadotropic hypogonadal men who remained azoospermic following gonadotropin therapy. Methods: We conducted a retrospective evaluation of microscopic TESE and ICSI outcomes in hypogonadotropic hypogonadal patients who remained azoospermic after gonadotropin therapy between 2004 and 2024. Results: Sperm was successfully retrieved from 14 out of 17 patients (82.4%) after gonadotropin treatment. However, no statistically significant differences were found between patients with successful sperm retrieval and those without. ICSI outcomes were performed using frozen-thawed sperm in 12 of the 14 patients, while 2 patients did not proceed with ICSI outcomes. The mean age of the partners was 27 ± 7.1 years. A total of 25 high-quality embryos were transferred across 18 transfer cycles, yielding an implantation rate of 28%. Six cycles resulted in clinical pregnancy, and four of these pregnancies resulted in live births. Conclusions: Gonadotropin therapy can successfully reverse azoospermia in most hypogonadotrophic hypogonadal male patients. For those who remain azoospermic after gonadotropin treatment, testicular sperm can still be retrieved through microscopic TESE, offering a viable option for assisted reproductive technology and the potential for achieving live births.

Resumen

Antecedentes: Existen datos limitados sobre la tasa de recuperación de espermatozoides mediante la extracción testicular de esperma (TESE) en hombres azoospérmicos con hipogonadismo hipogonadotrópico, así como sobre los resultados de fertilización y embarazo asociados a la inyección intracitoplasmática de espermatozoides (ICSI) utilizando los espermatozoides recuperados. El objetivo de este estudio fue evaluar las tasas de recuperación de espermatozoides mediante TESE microscópica y analizar los resultados de la ICSI en hombres con hipogonadismo hipogonadotrópico que permanecieron azoospérmicos tras la terapia con gonadotropinas. Métodos: Se realizó una evaluación retrospectiva de los resultados de TESE microscópica e ICSI en pacientes con hipogonadismo hipogonadotrópico que permanecieron azoospérmicos después de la terapia con gonadotropinas entre 2004 y 2024. Resultados: Se recuperaron espermatozoides en 14 de los 17 pacientes (82.4%) tras el tratamiento con gonadotropinas. Sin embargo, no se encontraron diferencias estadísticamente significativas entre los pacientes con recuperación exitosa de espermatozoides y aquellos sin ella. Los resultados de la ICSI se realizaron utilizando espermatozoides congelados-descongelados en 12 de los 14 pacientes, mientras que 2 pacientes no continuaron con ICSI. La edad media de las parejas fue de 27 ± 7.1 años. Se transfirieron un total de 25 embriones de alta calidad en 18 ciclos de transferencia, con una tasa de implantación del 28%. Seis ciclos resultaron en embarazo clínico, y cuatro de estos embarazos culminaron en nacimientos vivos. Conclusiones: La terapia con gonadotropinas puede revertir con éxito la azoospermia en la mayoría de los pacientes varones con hipogonadismo hipogonadotrópico. Para aquellos que permanecen azoospérmicos tras el tratamiento con gonadotropinas, aún es posible recuperar espermatozoides testiculares mediante TESE microscópica, ofreciendo una opción viable dentro de la tecnología de reproducción asistida y la posibilidad de lograr nacimientos vivos.

Infertility; Azoospermia; Hypogonadotropic hypogonadism; Testicular sperm extraction; Intracytoplasmic sperm injection

Palabras Clave

Infertilidad; Azoospermia; Hipogonadismo hipogonadotrópico; Extracción testicular de esperma; Inyección intracitoplasmática de espermatozoides

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