Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations

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dc.authorscopusid23398404000
dc.authorscopusid23470471000
dc.authorscopusid55625109900
dc.authorscopusid57814618100
dc.authorscopusid57191592841
dc.authorscopusid56353118100
dc.authorscopusid6508134167
dc.contributor.authorRambhatla, Amarnath
dc.contributor.authorShah, Rupin
dc.contributor.authorZiouziou, Imad
dc.contributor.authorKothari, Priyank
dc.contributor.authorSalvio, Gianmaria
dc.contributor.authorGul, Murat
dc.contributor.authorHamoda, Taha
dc.date.accessioned2024-09-19T15:43:42Z
dc.date.available2024-09-19T15:43:42Z
dc.date.issued2024
dc.departmentHatay Mustafa Kemal Üniversitesien_US
dc.description.abstractPurpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines. Copyright © 2024 Korean Society for Sexual Medicine and Andrology.en_US
dc.description.sponsorshipKing Chien; Italian Society of Human Reproduction; Egyptian Society of Cardiology; Malaysian Society of Andrology; Società Italiana di Virologia, SIV; Italian Society of Andrology and Sexual Medicine; Romanian Association for Sexual Medicine; Egyptian Society for Sexual Medicine & Surgery; InaUA; Österreichische Gesellschaft für Dermatologie und Venerologie, OGDVen_US
dc.identifier.doi10.5534/WJMH.230339
dc.identifier.issn2287-4208
dc.identifier.scopus2-s2.0-85193998102en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.urihttps://doi.org/10.5534/WJMH.230339
dc.identifier.urihttps://hdl.handle.net/20.500.12483/14513
dc.identifier.volume42en_US
dc.indekslendigikaynakScopusen_US
dc.language.isoenen_US
dc.publisherKorean Society for Sexual Medicine and Andrologyen_US
dc.relation.ispartofWorld Journal of Men's Healthen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectAzoospermiaen_US
dc.subjectHypogonadismen_US
dc.subjectInfertility, maleen_US
dc.subjectSemenen_US
dc.subjectSperm retrievalen_US
dc.titleGlobal Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendationsen_US
dc.typeArticleen_US

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