Background: Non-obstructive azoospermia (NOA) is a frequent cause of male infertility, and microsurgical testicular sperm
extraction (micro-TESE) is an effective technique for sperm retrieval in NOA cases. While the use of hormone stimulation is
recommended in cases of secondary hypogonadism, there is still debate surrounding its practice in men with NOA and primary
hypogonadism prior to attempting surgical sperm retrieval. This study aimed at evaluating aromatase enzyme inhibitors (AEI)
administration prior to micro-TESE.
Methods: The study included 80 male patients presenting to the Andrology Outpatient Clinic of South Valley University Hospitals
between 2020 and 2023.
They were divided into 2 groups randomized by closed envelope:
Group (1) were subjected to AEI administration 3 months prior to micro TESE.
Control group (2) were not subjected to any treatment prior to micro TESE.
Results: 80 cases of micro-TESE were performed (56 unilateral and 24 bilateral) and testicular sperm retrieval rate (SRR) was
47.5%. There was no statistical difference in age, testicular size, clinical varicoceles and hormonal profiles between the two groups.
There were no significant differences in the outcomes of micro TESE, concentration of retrieved sperms and ICSI outcomes
between groups. Hormonal levels for FSH, LH and prolactin before and after treatment in each group did not change significantly.
Otherwise, significant increases in total testosterone levels were observed after treatment with AEI but not in the Control group.
Conclusions: Testicular microdissection is an effective and safe procedure for non-obstructive azoospermia patients, regardless
of the different preoperative data. While hormonal treatment with AEI results in significant increases in total testosterone levels,
it does not significantly impact the outcomes of micro-TESE, retrieved sperm concentration, or ICSI in men with NOA.