無精症病患 睪丸取精前先施打hCG可提高精蟲取出率

無精症病患 睪丸取精前先施打hCG可提高精蟲取出率

1. 經睪丸取精沒發現精蟲之病患 於第二次睪丸取精前先施打HCG，有21%的病患可取出精蟲‧

2. 可能機轉: hCG可能作用於睪丸內之 Leydig cells，刺激其精蟲生成 .

Hum Reprod. 2011 Nov 28. [Epub ahead of print]

Human chorionic gonadotrophin treatment prior to microdissection testicular sperm extraction in non-obstructive azoospermia.

Shiraishi K, Ohmi C, Shimabukuro T, Matsuyama H.

Source

Department of Urology, Yamaguchi University School of Medicine, 111 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.

Abstract

BACKGROUNDDespite the improved success rate of sperm retrieval by microdissection testicular sperm extraction (micro-TESE), methods to stimulate spermatogenesis in men with non-obstructive azoospermia (NOA) remain unexplored. The aim of this study was to evaluate the effects of hCG-based hormonal stimulation in men with NOA on the success of sperm retrieval by micro-TESE.METHODSForty-eight men with NOA who had negative sperm retrieval results by the micro-TESE procedure were included. A second micro-TESE was subsequently performed on these men: 20 were not treated by any hormonal therapy, and 28 subjects received daily subcutaneous injections of hCG for 4-5 months prior to the second micro-TESE. Recombinant FSH was added if endogenous gonadotrophin levels decreased during the hCG stimulation. The sperm retrieval rate at the second micro-TESE; the levels of gonadotrophins, testosterone and estradiol; and the effects of hormonal therapy on testicular histology were evaluated.RESULTSAmong the 28 men with hCG stimulation, 15 (54%) showed decreased LH and FSH levels (0.67 ± 0.10 and 0.96 ± 0.14 mIU, mean ± SEM, respectively) due to elevated serum testosterone (9.5 ng/dl). Sperm were obtained at the second micro-TESE from six men who had received hormonal therapy (21%), whereas no sperm were retrieved from untreated men (P < 0.05). Success at the second micro-TESE was more likely if histology at the first micro-TESE showed hypospermatogenesis.CONCLUSIONSThe Leydig cells of the testis can respond positively to exogenous hCG even under hypergonadotropic conditions. HCG-based hormonal therapy prior to a second micro-TESE attempt is effective in men with hypospermatogenesis.