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.
| Original language | English |
|---|---|
| Pages (from-to) | 92-122 |
| Number of pages | 31 |
| Journal | World Journal of Men's Health |
| Volume | 43 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2025 |
Bibliographical note
Copyright 2024 Korean Society for Sexual Medicine and Andrology. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.Keywords
- Azoospermia
- Hypogonadism
- Infertility, male
- Semen
- Sperm retrieval
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In: World Journal of Men's Health, Vol. 43, No. 1, 01.2025, p. 92-122.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Global practice patterns and variations in the medical and surgical management of non-obstructive azoospermia
T2 - results of a world-wide survey, guidelines and expert recommendations
AU - Rambhatla, Amarnath
AU - Shah, Rupin
AU - Ziouziou, Imad
AU - Kothari, Priyank
AU - Salvio, Gianmaria
AU - Gul, Murat
AU - Hamoda, Taha
AU - Kavoussi, Parviz
AU - Atmoko, Widi
AU - Toprak, Tuncay
AU - Birowo, Ponco
AU - Ko, Edmund
AU - Arafa, Mohamed
AU - Ghayda, Ramy Abou
AU - Karthikeyan, Vilvapathy Senguttuvan
AU - Russo, Giorgio Ivan
AU - Pinggera, Germar Michael
AU - Chung, Eric
AU - Harraz, Ahmed M.
AU - Martinez, Marlon
AU - Phuoc, Nguyen Ho Vinh
AU - Tadros, Nicholas
AU - Saleh, Ramadan
AU - Savira, Missy
AU - Colpi, Giovanni M.
AU - Zohdy, Wael
AU - Pescatori, Edoardo
AU - Park, Hyun Jun
AU - Fukuhara, Shinichiro
AU - Tsujimura, Akira
AU - Rojas-Cruz, Cesar
AU - Marino, Angelo
AU - Mak, Siu King
AU - Amar, Edouard
AU - Ibrahim, Wael
AU - Sindhwani, Puneet
AU - Alhathal, Naif
AU - Busetto, Gian Maria
AU - Al Hashimi, Manaf
AU - El-Sakka, Ahmed
AU - Ramazan, Asci
AU - Dimitriadis, Fotios
AU - Timpano, Massimiliano
AU - Jezek, Davor
AU - Altay, Baris
AU - Zylbersztejn, Daniel Suslik
AU - Wong, Michael Y. C.
AU - Moon, Du Geon
AU - Wyns, Christine
AU - Gamidov, Safar
AU - Akhavizadegan, Hamed
AU - Franceschelli, Alessandro
AU - Aydos, Kaan
AU - Quang, Nguyen
AU - Ashour, Shedeed
AU - Al Dayel, Adel
AU - Al-Marhoon, Mohammed S.
AU - Micic, Sava
AU - Binsaleh, Saleh
AU - Hussein, Alayman
AU - Elbardisi, Haitham
AU - Mostafa, Taymour
AU - Ramsay, Jonathan
AU - Zachariou, Athanasios
AU - Abdelrahman, Islam Fathy Soliman
AU - Rajmil, Osvaldo
AU - Kalkanli, Arif
AU - Molina, Juan Manuel Corral
AU - Bocu, Kadir
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AU - Çeker, Gökhan
AU - Serefoglu, Ege Can
AU - Bahar, Fahmi
AU - Gherabi, Nazim
AU - Kuroda, Shinnosuke
AU - Bouzouita, Abderrazak
AU - Gudeloglu, Ahmet
AU - Ceyhan, Erman
AU - Hasan, Mohamed Saeed Mohamed
AU - Musa, Muhammad Ujudud
AU - Motawi, Ahmad
AU - Cho, Chak Lam
AU - Taniguchi, Hisanori
AU - Ho, Christopher Chee Kong
AU - Vazquez, Jesus Fernando Solorzano
AU - Mutambirwa, Shingai
AU - Gungor, Nur Dokuzeylul
AU - Bendayan, Marion
AU - Giulioni, Carlo
AU - Baser, Aykut
AU - Falcone, Marco
AU - Boeri, Luca
AU - Blecher, Gideon
AU - Kheradmand, Alireza
AU - Sethupathy, Tamilselvi
AU - Adriansjah, Ricky
AU - Narimani, Nima
AU - Konstantinidis, Charalampos
AU - Nguyen, Tuan Thanh
AU - Japari, Andrian
AU - Dolati, Parisa
AU - Singh, Keerti
AU - Ozer, Cevahir
AU - Sarikaya, Selcuk
AU - Sheibak, Nadia
AU - Bosco, Ndagijimana Jean
AU - Özkent, Mehmet Serkan
AU - Le, Sang Thanh
AU - Sokolakis, Ioannis
AU - Katz, Darren
AU - Smith, Ryan
AU - Truong, Manh Nguyen
AU - Le, Tan V.
AU - Huang, Zhongwei
AU - Deger, Muslim Dogan
AU - Arslan, Umut
AU - Calik, Gokhan
AU - Franco, Giorgio
AU - Rashed, Ayman
AU - Kahraman, Oguzhan
AU - Andreadakis, Sotiris
AU - Putra, Rosadi
AU - Balercia, Giancarlo
AU - Khalafalla, Kareim
AU - Cannarella, Rossella
AU - Tuân, Anh Đăng
AU - Meliegy, Amr El
AU - Zilaitiene, Birute
AU - Ramirez, Marlene Lizbeth Zamora
AU - Giacone, Filippo
AU - Calogero, Aldo E.
AU - Makarounis, Konstantinos
AU - Jindal, Sunil
AU - Hoai, Bac Nguyen
AU - Banthia, Ravi
AU - Peña, Marcelo Rodriguez
AU - Moorthy, Dharani
AU - Adamyan, Aram
AU - Kulaksiz, Deniz
AU - Kandil, Hussein
AU - Sofikitis, Nikolaos
AU - Salzano, Ciro
AU - Jungwirth, Andreas
AU - Banka, Surendra Reddy
AU - Mierzwa, Tiago Cesar
AU - Turunç, Tahsin
AU - Jain, Divyanu
AU - Avoyan, Armen
AU - Salacone, Pietro
AU - Kadıoğlu, Ateş
AU - Gupta, Chirag
AU - Lin, Haocheng
AU - Shamohammadi, Iman
AU - Mogharabian, Nasser
AU - Barrett, Trenton
AU - Danacıoğlu, Yavuz Onur
AU - Crafa, Andrea
AU - Daoud, Salima
AU - Malhotra, Vineet
AU - Almardawi, Abdulmalik
AU - Selim, Osama Mohamed
AU - Moussa, Mohamad
AU - Haghdani, Saeid
AU - Duran, Mesut Berkan
AU - Kunz, Yannic
AU - Preto, Mirko
AU - Eugeni, Elena
AU - Nguyen, Thang
AU - Elshahid, Ahmed Rashad
AU - Suyono, Seso Sulijaya
AU - Parikesit, Dyandra
AU - Nada, Essam
AU - Orozco, Eduardo Gutiérrez
AU - Boitrelle, Florence
AU - Trang, Nguyen Thi Minh
AU - Jamali, Mounir
AU - Nair, Raju
AU - Ruzaev, Mikhail
AU - Gadda, Franco
AU - Thomas, Charalampos
AU - Ferreira, Raphael Henrique
AU - Gul, Umit
AU - Maruccia, Serena
AU - Kanbur, Ajay
AU - Kinzikeeva, Ella
AU - Abumelha, Saad Mohammed
AU - Kosgi, Raghavender
AU - Gokalp, Fatih
AU - Soebadi, Mohammad Ayodhia
AU - Paul, Gustavo Marquesine
AU - Sajadi, Hesamoddin
AU - Gupte, Deepak
AU - Ambar, Rafael F.
AU - Sogutdelen, Emrullah
AU - Singla, Karun
AU - Basukarno, Ari
AU - Kim, Shannon Hee Kyung
AU - Gilani, Mohammad Ali Sadighi
AU - Nagao, Koichi
AU - Brodjonegoro, Sakti Ronggowardhana
AU - Rezano, Andri
AU - Elkhouly, Mohamed
AU - Mazzilli, Rossella
AU - Farsi, Hasan M. A.
AU - Ba, Hung Nguyen
AU - Alali, Hamed
AU - Kafetzis, Dimitrios
AU - Long, Tran Quang Tien
AU - Alsaid, Sami
AU - Cuong, Hoang Bao Ngoc
AU - Oleksandr, Knigavko
AU - Mustafa, Akhmad
AU - Acosta, Herik
AU - Pai, Hrishikesh
AU - Şahin, Bahadır
AU - Arianto, Eko
AU - Teo, Colin
AU - Jayaprakash, Sanjay Prakash
AU - Rachman, Rinaldo Indra
AU - Yenice, Mustafa Gurkan
AU - Sefrioui, Omar
AU - Priyadarshi, Shivam
AU - Tanic, Marko
AU - Alfatlaw, Noor Kareem
AU - Rizaldi, Fikri
AU - Vishwakarma, Ranjit B.
AU - Kanakis, George
AU - Cherian, Dinesh Thomas
AU - Lee, Joe
AU - Galstyan, Raisa
AU - Keskin, Hakan
AU - Wurzacher, Janan
AU - Seno, Doddy Hami
AU - Noegroho, Bambang S.
AU - Margiana, Ria
AU - Javed, Qaisar
AU - Castiglioni, Fabrizio
AU - Tanwar, Raman
AU - Puigvert, Ana
AU - Kaya, Coşkun
AU - Purnomo, Medianto
AU - Yazbeck, Chadi
AU - Amir, Azwar
AU - Borges, Edson
AU - Bellavia, Marina
AU - Deswanto, Isaac Ardianson
AU - Vinod, K. V.
AU - Liguori, Giovanni
AU - Minh, Dang Hoang
AU - Siddiqi, Kashif
AU - Colombo, Fulvio
AU - Zini, Armand
AU - Patel, Niket
AU - Çayan, Selahittin
AU - Al-Kawaz, Ula
AU - Ragab, Maged
AU - Hebrard, Guadalupe Hernández
AU - de la Rosette, Jean
AU - Efesoy, Ozan
AU - Hoffmann, Ivan
AU - Teixeira, Thiago Afonso
AU - Saylam, Barış
AU - Delgadillo, Daniela
AU - Agarwal, Ashok
AU - Global Andrology Forum
N1 - Copyright 2024 Korean Society for Sexual Medicine and Andrology. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2025/1
Y1 - 2025/1
N2 - 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.
AB - 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.
KW - Azoospermia
KW - Hypogonadism
KW - Infertility, male
KW - Semen
KW - Sperm retrieval
UR - http://www.scopus.com/inward/record.url?scp=85193998102&partnerID=8YFLogxK
U2 - 10.5534/WJMH.230339
DO - 10.5534/WJMH.230339
M3 - Article
C2 - 38606867
AN - SCOPUS:85193998102
SN - 2287-4208
VL - 43
SP - 92
EP - 122
JO - World Journal of Men's Health
JF - World Journal of Men's Health
IS - 1
ER -