Relationship between Hormonal Profile and Therapeutic Testicular Biopsy/ TESE Findings in Azoospermic Men

Abstract

Background: Ten to twenty per cent of infertile men are azoospermic. Luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone, control development and maturation of the gonad as well as spermatozoa production. Understanding these hormonal interactions have significant clinical consequences in the evaluation and treatment of azoospermic men.
Objective: To determine the pattern of hormonal derangement in azoospermic men, the histology of testicular tissue obtained at therapeutic testicular biopsy/ testicular sperm extraction (TESE) and the relationship between hormonal profile and histology of testicular tissue.
Methodology: This study was conducted on patients with infertility from 2015 to 2019 in a fertility centre in Jos, Nigeria. Clinical evaluation included history, physical examination and seminal fluid analyses. Azoospermic men had hormonal profiles (FSH, LH, Prolactin and Testosterone) assay and subsequently counselled for therapeutic testicular biopsy/ testicular sperm extraction for artificial reproductive technology. Hormonal assay levels and histologic findings were analysed, using SPSS version 23.
Results: Twenty-nine (n=29) men with azoospermia were analysed in this study. The mean age was 36.97±8.28 years with a range of 24-56years. Eight patients (n=8, 27.59%) had normal spermatogenesis while twenty-one patients (n=21, 72.41%) had various forms of abnormality, the commonest being spermatogenic arrest 31%. All patients with normal spermatogenesis (27.59%) and spermatogenic arrest at spermatocyte level(24.14%) had normal FSH and LH levels. FSH showed a strong correlation with testicular function, LH showed strong correlation while Prolactin showed negligible correlation.
Conclusion: Hormonal profile of azoospermic men can provide an insight into the possibility of testicular sperm retrieval. Normal hormonal levels do not indicate adequate testicular sperm (spermatogenic arrest at spermatocyte level) at therapeutic testicular biopsy/TESE. Elevated hormonal levels, however, indicate various forms of impaired spermatogenesis, these men should be advised to have donor sperm backup for ICSI.

Keywords: Infertility, Azoospermia, Hormonal profile, FSH, LH, Therapeutic testicular biopsy, TESE