Changes in Testosterone Levels Following Surgical Sperm Retrieval in Men with Non-Obstructive Azoospermia: Systematic Review and Meta-Analysis

Wael Zohdy; Rupin Shah; Christopher Chee Kong Ho; Gokhan Calik; Vineet Malhotra; Bircan Kolbaşı Erkan; Mesut Berkan Duran; Georgios Tsampoukas; Garaz Radion; Ramadan Saleh; Ahmed M Harraz; Parviz Kavoussi; Eric Chung; Edmund Ko; Luca Boeri; Naveen Kumar; Selahittin Çayan; Amarnath Rambhatla; Osvaldo Rajmil; Mohamed Arafa; Rossella Cannarella; Omer Raheem; Taymour Mostafa; Widi Atmoko; Taha Abo-Almagd Abdel-Meguid Hamoda; Armand Zini; Ashok Agarwal

doi:10.5534/wjmh.240129

Changes in Testosterone Levels Following Surgical Sperm Retrieval in Men with Non-Obstructive Azoospermia: Systematic Review and Meta-Analysis

World J Mens Health. 2024 Sep 10. doi: 10.5534/wjmh.240129. Online ahead of print.

Authors

Wael Zohdy^{1

2}, Rupin Shah^{2

3}, Christopher Chee Kong Ho^{2

4}, Gokhan Calik^{2

5}, Vineet Malhotra^{2

6}, Bircan Kolbaşı Erkan^{2

7}, Mesut Berkan Duran^{2

8}, Georgios Tsampoukas^{2

9

10}, Garaz Radion^{2

11}, Ramadan Saleh^{2

12

13}, Ahmed M Harraz^{2

14

15

16}, Parviz Kavoussi^{2

17}, Eric Chung^{2

18}, Edmund Ko^{2

19}, Luca Boeri^{2

20}, Naveen Kumar^{2

21}, Selahittin Çayan^{2

22}, Amarnath Rambhatla^{2

23}, Osvaldo Rajmil^{2

24

25}, Mohamed Arafa^{1

2

26

27}, Rossella Cannarella^{2

28

29}, Omer Raheem^{2

30}, Taymour Mostafa^{1

2}, Widi Atmoko^{2

31}, Taha Abo-Almagd Abdel-Meguid Hamoda^{2

32

33}, Armand Zini^{2

34}, Ashok Agarwal^{2

35}

Affiliations

¹ Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt.
² Global Andrology Forum, Moreland Hills, OH, USA.
³ Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.
⁴ Department of Surgery, School of Medicine, Taylor's University, Subang Jaya, Selangor, Malaysia.
⁵ Department of Urology, Istanbul Medipol University, Istanbul, Türkiye.
⁶ Department of Urology, VNA Hospital, New Delhi, India.
⁷ Department of Histology and Embryology, Istanbul Medipol University, Istanbul, Türkiye.
⁸ Department of Urology, Pamukkale University School of Medicine, Denizli, Türkiye.
⁹ Department of Urology, Princess Alexandra Hospital, Harlow, UK.
¹⁰ U-merge Ltd, Urology for Emerging Countries, London, UK.
¹¹ Department of Urology, University Hospital of Tübingen, Tübingen, Germany.
¹² Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.
¹³ Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt.
¹⁴ Mansoura University Urology and Nephrology Center, Mansoura, Egypt.
¹⁵ Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait.
¹⁶ Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait.
¹⁷ Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA.
¹⁸ Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia.
¹⁹ Department of Urology, Loma Linda University Health, Loma Linda, CA, USA.
²⁰ Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
²¹ Department of Urology, All India Institute of Medical Sciences, Patna, India.
²² Department of Urology, University of Mersin School of Medicine, Mersin, Türkiye.
²³ Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
²⁴ Andrology Department, Fundació Puigvert, Barcelona, Spain.
²⁵ Instituto de Investigaciones Biomédicas Sant Pau, IIB-Sant Pau, Universitat Autò noma de Barcelona, Barcelona, Spain.
²⁶ Department of Urology, Hamad Medical Corporation, Doha, Qatar.
²⁷ Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar.
²⁸ Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
²⁹ Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
³⁰ Department of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA.
³¹ Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
³² Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia.
³³ Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt.
³⁴ Division of Urology, Department of Surgery, The Royal Victoria Hospital, McGill University, Montreal, QC, Canada.
³⁵ Cleveland Clinic Foundation, Cleveland, OH, USA. agarwaa32099@outlook.com.

PMID: 39344115
DOI: 10.5534/wjmh.240129

Abstract

Purpose: Surgical sperm retrieval (SSR) is used to extract spermatozoa for use with intracytoplasmic sperm injection in men with obstructive and non-obstructive azoospermia (NOA). The procedure may lead to segmental devascularization, postoperative fibrosis, and atrophy with a subsequent decrease in testosterone. The aim of the study is to investigate the impact of SSR on serum levels of total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH) testicular volume, and sexual function in infertile azoospermic men.

Materials and methods: In this systematic review and meta-analysis (SRMA), we searched articles in "PubMed" and "Scopus" exploring the impact of SSR on TT, FSH, LH, and testicular volume. The full-text articles were screened to assess eligibility before data extraction, quality assessment, and meta-analysis.

Results: Seventeen studies meeting the inclusion criteria were finally analyzed and included 1,685 infertile, azoospermic men. Patients underwent SSR and were followed in the postoperative period (one week to 32 months). The analysis showed a significant reduction in TT (mean difference [MD] 3.81 nmol/L, 95% confidence interval [CI] 0.55:7.06; p=0.02) compared to pre-SSR values. We also observed insignificant differences in serum FSH (MD 5.08 IU/L, 95% CI -5.6:15.8; p=0.35), LH (MD -2.96 IU/L, 95% CI -6.31:0.39; p=0.08), and no change in testicular volume (MD 0.07 mL, 95% CI -1.92:2.07; p=0.94) after SSR. Sexual dysfunction was associated with hypogonadism, depression, and anxiety, especially in men with unsuccessful SSR and Klinefelter syndrome.

Conclusions: The results of this SRMA indicate a significant reduction in TT after SSR. Sexual dysfunction after testicular sperm extraction and the potential negative impact of future SSR repeat should be considered during preoperative counseling.

Keywords: Azoospermia; Hypogonadism; Microsurgical testicular sperm retrieval; Sperm injections, intracytoplasmic; Testicular sperm extraction.