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.

Journal: The World Journal Of Men's Health

Published: November 22, 2023

Abstract

Objective: 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.

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.

Authors

Amarnath Rambhatla, Rupin Shah, Imad Ziouziou, Priyank Kothari, Gianmaria Salvio, Murat Gul, Taha Hamoda, Parviz Kavoussi, Widi Atmoko, Tuncay Toprak, Ponco Birowo, Edmund Ko, Mohamed Arafa, Ramy Ghayda, Vilvapathy Karthikeyan, Giorgio Russo, Germar-michael Pinggera, Eric Chung, Ahmed Harraz, Marlon Martinez, Nguyen Ho Phuoc, Nicholas Tadros, Ramadan Saleh, Missy Savira, Giovanni Colpi, Wael Zohdy, Edoardo Pescatori, Hyun Park, Shinichiro Fukuhara, Akira Tsujimura, Cesar Rojas Cruz, Angelo Marino, Siu Mak, Edouard Amar, Wael Ibrahim, Puneet Sindhwani, Naif Alhathal, Gian Busetto, Manaf Al Hashimi, Ahmed El Sakka, Asci Ramazan, Fotios Dimitriadis, Massimiliano Timpano, Davor Jezek, Baris Altay, Daniel Zylbersztejn, Michael Wong, Du Moon, Christine Wyns, Safar Gamidov, Hamed Akhavizadegan, Alessandro Franceschelli, Kaan Aydos, Nguyen Quang, Shedeed Ashour, Adel Al Dayel, Mohammed Al Marhoon, Sava Micic, Saleh Binsaleh, Alayman Hussein, Haitham Elbardisi, Taymour Mostafa, Jonathan Ramsay, Athanasios Zachariou, Islam Fathy Abdelrahman, Osvaldo Rajmil, Arif Kalkanli, Juan Manuel Molina, Kadir Bocu, Gede Wirya Duarsa, Gökhan Çeker, Ege Serefoglu, Fahmi Bahar, Nazim Gherabi, Shinnosuke Kuroda, Abderrazak Bouzouita, Ahmet Gudeloglu, Erman Ceyhan, Mohamed Hasan, Muhammad Musa, Ahmad Motawi, Chak-lam Cho, Hisanori Taniguchi, Christopher Chee Ho, Jesus Fernando Vazquez, Shingai Mutambirwa, Nur Gungor, Marion Bendayan, Carlo Giulioni, Aykut Baser, Marco Falcone, Luca Boeri, Gideon Blecher, Alireza Kheradmand, Tamilselvi Sethupathy, Ricky Adriansjah, Nima Narimani, Charalampos Konstantinidis, Tuan Nguyen, Andrian Japari, Parisa Dolati, Keerti Singh, Cevahir Ozer, Selcuk Sarikaya, Nadia Sheibak, Ndagijimana Bosco, Mehmet Özkent, Sang Le, Ioannis Sokolakis, Darren Katz, Ryan Smith, Manh Truong, Tan Le, Zhongwei Huang, Muslim Deger, Umut Arslan, Gokhan Calik, Giorgio Franco, Ayman Rashed, Oguzhan Kahraman, Sotiris Andreadakis, Rosadi Putra, Giancarlo Balercia, Kareim Khalafalla, Rossella Cannarella, Anh Tuấn, Amr El Meliegy, Birute Zilaitiene, Marlene Lizbeth Ramirez, Filippo Giacone, Aldo Calogero, Konstantinos Makarounis, Sunil Jindal, Bac Hoai, Ravi Banthia, Marcelo Peña, Dharani Moorthy, Aram Adamyan, Deniz Kulaksiz, Hussein Kandil, Nikolaos Sofikitis, Ciro Salzano, Andreas Jungwirth, Surendra Banka, Tiago Mierzwa, Tahsin Turunç, Divyanu Jain, Armen Avoyan, Pietro Salacone, Ateş Kadıoğlu, Chirag Gupta, Haocheng Lin, Iman Shamohammadi, Nasser Mogharabian, Trenton Barrett, Yavuz Danacıoğlu, Andrea Crafa, Salima Daoud, Vineet Malhotra, Abdulmalik Almardawi, Osama Selim, Mohamad Moussa, Saeid Haghdani, Mesut Duran, Yannic Kunz, Mirko Preto, Elena Eugeni, Thang Nguyen, Ahmed Elshahid, Seso Suyono, Dyandra Parikesit, Essam Nada, Eduardo Orozco, Florence Boitrelle, Nguyen Thi Trang, Mounir Jamali, Raju Nair, Mikhail Ruzaev, Franco Gadda, Charalampos Thomas, Raphael Ferreira, Umit Gul, Serena Maruccia, Ajay Kanbur, Ella Kinzikeeva, Saad Abumelha, Raghavender Kosgi, Fatih Gokalp, Mohammad Soebadi, Gustavo Paul, Hesamoddin Sajadi, Deepak Gupte, Rafael Ambar, Emrullah Sogutdelen, Karun Singla, Ari Basukarno, Shannon Hee Kim, Mohammad Ali Gilani, Koichi Nagao, Sakti Brodjonegoro, Andri Rezano, Mohamed Elkhouly, Rossella Mazzilli, Hasan M Farsi, Hung Ba, Hamed Alali, Dimitrios Kafetzis, Tran Quang Long, Sami Alsaid, Hoang Bao Cuong, Knigavko Oleksandr, Akhmad Mustafa, Herik Acosta, Hrishikesh Pai, Bahadır Şahin, Eko Arianto, Colin Teo, Sanjay Jayaprakash, Rinaldo Rachman, Mustafa Yenice, Omar Sefrioui, Shivam Priyadarshi, Marko Tanic, Noor Alfatlaw, Fikri Rizaldi, Ranjit Vishwakarma, George Kanakis, Dinesh Cherian, Joe Lee, Raisa Galstyan, Hakan Keskin, Janan Wurzacher, Doddy Seno, Bambang Noegroho, Ria Margiana, Qaisar Javed, Fabrizio Castiglioni, Raman Tanwar, Ana Puigvert, Coşkun Kaya, Medianto Purnomo, Chadi Yazbeck, Azwar Amir, Edson Borges, Marina Bellavia, Isaac Deswanto, Vinod Kv, Giovanni Liguori, Dang Minh, Kashif Siddiqi, Fulvio Colombo, Armand Zini, Niket Patel, Selahittin Çayan, Ula Al Kawaz, Maged Ragab, Guadalupe Hebrard, Jean De La Rosette, Ozan Efesoy, Ivan Hoffmann, Thiago Teixeira, Barış Saylam, Daniela Delgadillo, Ashok Agarwal

Relevant Conditions

Intersex, Infertility, Varicocele, Klinefelter Syndrome, Hypogonadism

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.

Similar Publications