THIAGO NUNES, RICARDO SAADE
SAO PAULO, Brazil
INTRODUCTION AND OBJECTIVES
Currently, treatment of men with nonobstructive azoospermia (NOA) is accomplished through assisted reproduction using testicular sperm retrieval techniques combined with in vitro fertilization (IVF) by intracytoplasmic sperm injection technique (ICSI).
Among the sperm retrieval techniques, testicular microdissection (micro-TESE) is presenting the best results, with approximately 50% of success. In order to optimize the spermatogenesis process before the procedure, new therapies are being used towards a better chance of success in the recovery of sperm for IVF, through prior drug treatment.
There is no consensus in the literature on the effectiveness of this treatment. The objective of this study was to conduct a systematic review regarding the use of previous clinical treatment for sperm retrieval in men with NOA, comparing sperm retrieval rates (SRR), drug used, levels of FSH / testosterone and the relationship with the testicular histology
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols (PRISMA-P) 2015 statement. A total of 53 analyzed studies were selected 7 for the final analysis
The SRR with micro-TESE in the treated group ranged from 51.0 to 77.0%, while in the control group ranged from 33.0 to 51.0%. Regarding the medication used, it was not possible to compare the results of the studies, but men with Klinefelter Syndrome (KS), responded better to aromatase inhibitor (AI). With respect to hormone levels, we see improvement with treatment in the group of subjects with normal FSH levels. In the case of KS, with high levels of FSH and low levels of testosterone, SRR was also better when individuals showed an increase in testosterone levels. Regarding the histology of biopsy, the best responses were in patients with hypospermatogenesis (HS) and maturation arrest (MA), except in SK
The studies analyzed lead to the conclusion that the medical treatment in men with NOA, when the FSH levels are normal, histology showed MA or HS and men with KS, with high FSH levels and low levels of T. New prospectives randomized studies are needed to prove the real benefit of these treatments.