Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. Materials and methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.
Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations / Rambhatla, Amarnath; Shah, Rupin; Ziouziou, Imad; Kothari, Priyank; Salvio, Gianmaria; Gul, Murat; Hamoda, Taha; Kavoussi, Parviz; Atmoko, Widi; Toprak, Tuncay; Birowo, Ponco; Ko, Edmund; Arafa, Mohamed; Ghayda, Ramy Abou; Karthikeyan, Vilvapathy Senguttuvan; Russo, Giorgio Ivan; Pinggera, Germar-Michael; Chung, Eric; Harraz, Ahmed M.; Martinez, Marlon; Phuoc, Nguyen Ho Vinh; Tadros, Nicholas; Saleh, Ramadan; Savira, Missy; Colpi, Giovanni M.; Zohdy, Wael; Pescatori, Edoardo; Park, Hyun Jun; Fukuhara, Shinichiro; Tsujimura, Akira; Rojas-Cruz, Cesar; Marino, Angelo; Mak, Siu King; Amar, Edouard; Ibrahim, Wael; Sindhwani, Puneet; Alhathal, Naif; Busetto, Gian Maria; Hashimi, Manaf Al; El-Sakka, Ahmed; Ramazan, Asci; Dimitriadis, Fotios; Timpano, Massimiliano; Jezek, Davor; Altay, Baris; Zylbersztejn, Daniel Suslik; Wong, Michael YC; Moon, Du Geon; Wyns, Christine; Gamidov, Safar; Akhavizadegan, Hamed; Franceschelli, Alessandro; Aydos, Kaan; Quang, Nguyen; Ashour, Shedeed; Dayel, Adel Al; Al-Marhoon, Mohammed S.; Micic, Sava; Binsaleh, Saleh; Hussein, Alayman; Elbardisi, Haitham; Mostafa, Taymour; Ramsay, Jonathan; Zachariou, Athanasios; Abdelrahman, Islam Fathy Soliman; Rajmil, Osvaldo; Kalkanli, Arif; Molina, Juan Manuel Corral; Bocu, Kadir; Duarsa, Gede Wirya Kusuma; Çeker, Gökhan; Serefoglu, Ege Can; Bahar, Fahmi; Gherabi, Nazim; Kuroda, Shinnosuke; Bouzouita, Abderrazak; Gudeloglu, Ahmet; Ceyhan, Erman; Hasan, Mohamed Saeed Mohamed; Musa, Muhammad Ujudud; Motawi, Ahmad; Cho, Chak-Lam; Taniguchi, Hisanori; Ho, Christopher Chee Kong; Vazquez, Jesus Fernando Solorzano; Mutambirwa, Shingai; Gungor, Nur Dokuzeylul; Bendayan, Marion; Giulioni, Carlo; Baser, Aykut; Falcone, Marco; Boeri, Luca; Blecher, Gideon; Kheradmand, Alireza; Sethupathy, Tamilselvi; Adriansjah, Ricky; Narimani, Nima; Konstantinidis, Charalampos; Nguyen, Tuan Thanh; Japari, Andrian; Dolati, Parisa; Singh, Keerti; Ozer, Cevahir; Sarikaya, Selcuk; Sheibak, Nadia; Bosco, Ndagijimana Jean; Özkent, Mehmet Serkan; Le, Sang Thanh; Sokolakis, Ioannis; Katz, Darren; Smith, Ryan; Truong, Manh Nguyen; Le, Tan V.; Huang, Zhongwei; Deger, Muslim Dogan; Arslan, Umut; Calik, Gokhan; Franco, Giorgio; Rashed, Ayman; Kahraman, Oguzhan; Andreadakis, Sotiris; Putra, Rosadi; Balercia, Giancarlo; Khalafalla, Kareim; Cannarella, Rossella; Tuấn, Anh Đặng; El Meliegy, Amr; Zilaitiene, Birute; Ramirez, Marlene Lizbeth Zamora; Giacone, Filippo; Calogero, Aldo E.; Makarounis, Konstantinos; Jindal, Sunil; Hoai, Bac Nguyen; Banthia, Ravi; Peña, Marcelo Rodriguez; Moorthy, Dharani; Adamyan, Aram; Kulaksiz, Deniz; Kandil, Hussein; Sofikitis, Nikolaos; Salzano, Ciro; Jungwirth, Andreas; Banka, Surendra Reddy; Mierzwa, Tiago Cesar; Turunç, Tahsin; Jain, Divyanu; Avoyan, Armen; Salacone, Pietro; Kadıoğlu, Ateş; Gupta, Chirag; Lin, Haocheng; Shamohammadi, Iman; Mogharabian, Nasser; Barrett, Trenton; Danacıoğlu, Yavuz Onur; Crafa, Andrea; Daoud, Salima; Malhotra, Vineet; Almardawi, Abdulmalik; Selim, Osama Mohamed; Moussa, Mohamad; Haghdani, Saeid; Duran, Mesut Berkan; Kunz, Yannic; Preto, Mirko; Eugeni, Elena; Nguyen, Thang; Elshahid, Ahmed Rashad; Suyono, Seso Sulijaya; Parikesit, Dyandra; Nada, Essam; Orozco, Eduardo Gutiérrez; Boitrelle, Florence; Trang, Nguyen Thi Minh; Jamali, Mounir; Nair, Raju; Ruzaev, Mikhail; Gadda, Franco; Thomas, Charalampos; Ferreira, Raphael Henrique; Gul, Umit; Maruccia, Serena; Kanbur, Ajay; Kinzikeeva, Ella; Abumelha, Saad Mohammed; Kosgi, Raghavender; Gokalp, Fatih; Soebadi, Mohammad Ayodhia; Paul, Gustavo Marquesine; Sajadi, Hesamoddin; Gupte, Deepak; Ambar, Rafael F.; Sogutdelen, Emrullah; Singla, Karun; Basukarno, Ari; Kim, Shannon Hee Kyung; Gilani, Mohammad Ali Sadighi; Nagao, Koichi; Brodjonegoro, Sakti Ronggowardhana; Rezano, Andri; Elkhouly, Mohamed; Mazzilli, Rossella; Farsi, Hasan M. A.; Ba, Hung Nguyen; Alali, Hamed; Kafetzis, Dimitrios; Long, Tran Quang Tien; Alsaid, Sami; Cuong, Hoang Bao Ngoc; Oleksandr, Knigavko; Mustafa, Akhmad; Acosta, Herik; Pai, Hrishikesh; Şahin, Bahadır; Arianto, Eko; Teo, Colin; Jayaprakash, Sanjay Prakash; Rachman, Rinaldo Indra; Yenice, Mustafa Gurkan; Sefrioui, Omar; Priyadarshi, Shivam; Tanic, Marko; Alfatlaw, Noor Kareem; Rizaldi, Fikri; Vishwakarma, Ranjit B.; Kanakis, George; Cherian, Dinesh Thomas; Lee, Joe; Galstyan, Raisa; Keskin, Hakan; Wurzacher, Janan; Seno, Doddy Hami; Noegroho, Bambang S; Margiana, Ria; Javed, Qaisar; Castiglioni, Fabrizio; Tanwar, Raman; Puigvert, Ana; Kaya, Coşkun; Purnomo, Medianto; Yazbeck, Chadi; Amir, Azwar; Borges, Edson; Bellavia, Marina; Deswanto, Isaac Ardianson; Kv, Vinod; Liguori, Giovanni; Minh, Dang Hoang; Siddiqi, Kashif; Colombo, Fulvio; Zini, Armand; Patel, Niket; Çayan, Selahittin; Al-kawaz, Ula; Ragab, Maged; Hebrard, Guadalupe Hernández; de la Rosette, Jean; Efesoy, Ozan; Hoffmann, Ivan; Teixeira, Thiago Afonso; Saylam, Barış; Delgadillo, Daniela; Agarwal, Ashok; Null, Null. - In: THE WORLD JOURNAL OF MEN'S HEALTH. - ISSN 2287-4208. - 42:(2024). [10.5534/wjmh.230339]
Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations
Salvio, Gianmaria;Quang, Nguyen;Giulioni, Carlo;Franco, Giorgio;Balercia, Giancarlo;
2024-01-01
Abstract
Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. Materials and methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
