Non-obstructive Azoospermia Clinical Trial
Official title:
Anti-mullerian Hormone,Testesterone,Esrtadiol,Testesterone/Esrtadiol Ratio as Predictive Values for TESA and TESE Outcome in Non Obstructive Azoospermia
*Evaluate the predictive value of AMH, Testosterone,Estradiol,Testosterone Estradiol ratio for TESA and TESE outcome in non obstructive azoospermic patients.
- The relevance of male infertility has progressively grown , with significant medical,
psychological, and socio-economic implications. .. With no sperm found at multiple semen
analyses, non-obstructive azoospermia (NOA) is the most severe form of infertility.
- The introduction to clinical practice of assisted reproduction techniques such as
intra-cytoplasmic sperm injection (ICSI) made fatherhood possible for men with (NOA).
The extraction of sperm from the testis through testicular sperm aspiration (TESA),
testicular sperm extraction (TESE) or open biopsy can result in a favorable reproductive
outcome. Nevertheless, all these procedures are invasive in nature with variable
possibility of successful sperm extraction. As a consequence, a non-invasive test that
could predict the presence of sperm in men with NOA would be of profound clinical
importance
- However, the lack of useful predictive biomarkers suggestive for successful sperm
retrieval at microTESE and TESA in NOA men still represents a relevant gap with a very
negative return for the patient. Indeed, no significant association has been found
between microTESEand TESA sperm retrieval outcomes and preoperative testicular volume,
baseline follicular stimulating hormone (FSH) levels, basal level of Testosterone (T) or
increased T level following treatments with aromatase inhibitors, clomiphene citrate or
human chorionic gonadotropin.
- Therefore, it has been amust to identify novel and user-friendly prognostic factors
reliably predicting surgical outcomes in NOA men in the real-life setting. Among other
variables, some hormons can be subjected to studies for this purpose such as levels of
testis-derived hormones (which might be representative of the primary testicular
failure) as the Anti-Müllerian Hormone (AMH),( which is suggestive for a Sertoli cells'
immature phenotype),and testosterone of biological relevance...
- An investigation from the early 1970s demonstrated that the human testis does indeed
secrete estradiol within the spermatic vein, at amean concentration that is 50 times
greater than that inthe peripheral plasma . These findings led to the hypothesis that
local estrogen levels might be associated with the current stateof spermatogenesis, or
the total number of spermatogenic cells in the testis.
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