Non-obstructive azoospermia (NOA) is the most severe form of male factor infertility. It results form from either primary or secondary testicular failure. Here, we report cases of two patients with NOA due to maturation arrest and increased serum FSH, treated with GnRH agonist and gonadotrophins. The two NOA patients underwent a pharmacological treatment consisting of pituitary desensibilization using a GnRH agonist and testicular stimulation using menotropin. Testicular stimulation started one month after the beginning of GnRH agonist treatment. The female partner underwent controlled ovarian stimulation (COS) followed by intracytoplasmic sperm injection (ICSI). On the third day of the cycle, menotropin daily doses was administered. When at least one follicle ≥14 mm was visualized, pituitary blockage was performed using GnRH antagonist ganirelix. When three or more follicles attained a mean diameter of ≥17 mm, triptorelin acetate was administered to trigger final follicular maturation. Oocyte retrieval was performed 35 hours later. After treatment, male partner blood levels of the FSH, LH, decreased and total testosterone were increased. Spermatozoa was observed after semen collection in both cases. After COS, oocytes were retrieved and ICSI was performed. Embryos were biopsied for preimplantation genetic testing (PGT) and those considered euploidy were transferred resulting in positive implantation, ongoing pregnancy, and livebirth on both cases. In this report we present a successful strategy for hypergonadotropic hypogonadism AOA men, as an alternative approach to the surgical testicular sperm recovery. Nevertheless, prospective randomized trials are needed to confirm our findings.
JBRA assisted reproduction. 2024 Jun 14 [Epub ahead of print]
Mauro Bibancos de Rose, Arhon Bizelli Sicard, Natalia Alvarenga Aguiar, Beatriz de Oliveira Onório, Antonio Alberto Rodrigues Almendra, Wagner Eduardo Matheus, Andrea Garolla, Carlo Foresta, Daniela Paes de Almeida Ferreira Braga, Amanda Souza Setti, Edson Borges
Fertility Medical Group. São Paulo - SP, Brazil., Urology Department - Pontifícia Universidade Católica de Campinas - PUCAMP. Campinas - SP, Brazil., Urology Department - Universidade Estadual de Campinas - UNICAMP. Campinas - SP, Brazil., Unit of Andrology and Reproductive Medicine, Department of Medicine - University of Pandova. Pandova - PD, Italy., Fertility/FERTGROUP-Medicina Reprodutiva. São Paulo - SP, Brazil.