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

Amarnath Rambhatla (1) , Rupin Shah (2) , Imad Ziouziou (3) , Priyank Kothari , Gianmaria Salvio (4) , Murat Gul (5) , Taha Hamoda (6, 7) , Parviz Kavoussi , Widi Atmoko (8) , Tuncay Toprak , Ponco Birowo (8) , Edmund Ko (9) , Mohamed Arafa (10, 11, 12) , Ramy Abou Ghayda (13) , Vilvapathy Senguttuvan Karthikeyan (14) , Giorgio Ivan Russo (15) , Germar-Michael Pinggera (16) , Eric Chung (17) , Ahmed M Harraz (18) , Marlon Martinez (19) , Nguyen Ho Vinh Phuoc , Nicholas Tadros (20) , Ramadan Saleh (21) , Missy Savira (8) , Giovanni M Colpi , Wael Zohdy (11) , Edoardo Pescatori , Hyun Jun Park (22) , Shinichiro Fukuhara (23) , Akira Tsujimura (24) , Cesar Rojas-Cruz (25) , Angelo Marino , Siu King Mak , Edouard Amar (26) , Wael Ibrahim , Puneet Sindhwani (27) , Naif Alhathal (28) , Gian Maria Busetto (29) , Manaf Al Hashimi (30, 31) , Ahmed El-Sakka , Asci Ramazan (32) , Fotios Dimitriadis (33) , Massimiliano Timpano (34) , Davor Jezek (35) , Baris Altay (36) , Daniel Suslik Zylbersztejn (37) , Michael Yc Wong (38) , Du Geon Moon (39) , Christine Wyns (40) , Safar Gamidov (41) , Hamed Akhavizadegan , Alessandro Franceschelli (42) , Kaan Aydos (43) , Nguyen Quang (44) , Shedeed Ashour (11) , Adel Al Dayel , Mohammed S Al-Marhoon (45) , Sava Micic , Saleh Binsaleh (46) , Alayman Hussein (7) , Haitham Elbardisi (10, 12) , Taymour Mostafa (11) , Jonathan Ramsay (47) , Athanasios Zachariou (48) , Islam Fathy Soliman Abdelrahman (11) , Osvaldo Rajmil (49) , Arif Kalkanli , Juan Manuel Corral Molina (50) , Kadir Bocu (51) , Gede Wirya Kusuma Duarsa (52) , Gökhan Çeker , Ege Can Serefoglu (53) , Fahmi Bahar , Nazim Gherabi (54) , Shinnosuke Kuroda (55) , Abderrazak Bouzouita (56) , Ahmet Gudeloglu (57) , Erman Ceyhan (58) , Mohamed Saeed Mohamed Hasan , Muhammad Ujudud Musa , Ahmad Motawi (11) , Chak-Lam Cho (59) , Hisanori Taniguchi (60) , Christopher Chee Kong Ho (61) , Jesus Fernando Solorzano Vazquez , Shingai Mutambirwa (62) , Nur Dokuzeylul Gungor (63) , Marion Bendayan (64, 65) , Carlo Giulioni (4) , Aykut Baser , Marco Falcone (66) , Luca Boeri (67) , Gideon Blecher (68) , Alireza Kheradmand (69) , Tamilselvi Sethupathy , Ricky Adriansjah (70) , Nima Narimani (71) , Charalampos Konstantinidis , Tuan Thanh Nguyen (72) , Andrian Japari , Parisa Dolati (73) , Keerti Singh (74) , Cevahir Ozer (58) , Selcuk Sarikaya (75) , Nadia Sheibak (71) , Ndagijimana Jean Bosco (76) , Mehmet Serkan Özkent (77) , Sang Thanh Le (7) , Ioannis Sokolakis (78) , Darren Katz (79) , Ryan Smith , Manh Nguyen Truong (73) , Tan V Le (80) , Zhongwei Huang (81) , Muslim Dogan Deger , Umut Arslan (82) , Gokhan Calik (83) , Giorgio Franco , Ayman Rashed , Oguzhan Kahraman , Sotiris Andreadakis , Rosadi Putra , Giancarlo Balercia , Kareim Khalafalla , Rossella Cannarella , Anh Đặng Tuấn , Amr El Meliegy , Birute Zilaitiene , Marlene Lizbeth Zamora Ramirez , Filippo Giacone , Aldo E Calogero , Konstantinos Makarounis , Sunil Jindal , Bac Nguyen Hoai , Ravi Banthia , Marcelo Rodriguez Peña , Dharani Moorthy , Aram Adamyan , Deniz Kulaksiz , Hussein Kandil , Nikolaos Sofikitis , Ciro Salzano , Andreas Jungwirth , Surendra Reddy Banka , Tiago Cesar Mierzwa , Tahsin Turunç , Divyanu Jain , Armen Avoyan , Pietro Salacone , Ateş Kadıoğlu , Chirag Gupta , Haocheng Lin , Iman Shamohammadi , Nasser Mogharabian , Trenton Barrett , Yavuz Onur Danacıoğlu , Andrea Crafa , Salima Daoud , Vineet Malhotra , Abdulmalik Almardawi , Osama Mohamed Selim , Mohamad Moussa , Saeid Haghdani , Mesut Berkan Duran , Yannic Kunz , Mirko Preto , Elena Eugeni , Thang Nguyen , Ahmed Rashad Elshahid , Seso Sulijaya Suyono , Dyandra Parikesit , Essam Nada , Eduardo Gutiérrez Orozco , Florence Boitrelle (84, 85, 65) , Nguyen Thi Minh Trang , Mounir Jamali , Raju Nair , Mikhail Ruzaev , Franco Gadda , Charalampos Thomas , Raphael Henrique Ferreira , Umit Gul , Serena Maruccia , Ajay Kanbur , Ella Kinzikeeva , Saad Mohammed Abumelha , Raghavender Kosgi , Fatih Gokalp , Mohammad Ayodhia Soebadi , Gustavo Marquesine Paul , Hesamoddin Sajadi , Deepak Gupte , Rafael F Ambar , Emrullah Sogutdelen , Karun Singla , Ari Basukarno , Shannon Hee Kyung Kim , Mohammad Ali Sadighi Gilani , Koichi Nagao , Sakti Ronggowardhana Brodjonegoro , Andri Rezano , Mohamed Elkhouly , Rossella Mazzilli , Hasan M A Farsi , Hung Nguyen Ba , Hamed Alali , Dimitrios Kafetzis , Tran Quang Tien Long , Sami Alsaid , Hoang Bao Ngoc Cuong , Knigavko Oleksandr , Akhmad Mustafa , Herik Acosta , Hrishikesh Pai , Bahadır Şahin , Eko Arianto , Colin Teo , Sanjay Prakash Jayaprakash , Rinaldo Indra Rachman , Mustafa Gurkan Yenice , Omar Sefrioui , Shivam Priyadarshi , Marko Tanic , Noor Kareem Alfatlaw , Fikri Rizaldi , Ranjit B Vishwakarma , George Kanakis , Dinesh Thomas Cherian , Joe Lee , Raisa Galstyan , Hakan Keskin , Janan Wurzacher , Doddy Hami Seno , Bambang S Noegroho , Ria Margiana , Qaisar Javed , Fabrizio Castiglioni , Raman Tanwar , Ana Puigvert , Coşkun Kaya , Medianto Purnomo , Chadi Yazbeck , Azwar Amir , Edson Borges , Marina Bellavia , Isaac Ardianson Deswanto , Vinod Kv , Giovanni Liguori , Dang Hoang Minh , Kashif Siddiqi , Fulvio Colombo , Armand Zini , Niket Patel , Selahittin Çayan , Ula Al-Kawaz , Maged Ragab , Guadalupe Hernández Hebrard , Jean de la Rosette , Ozan Efesoy , Ivan Hoffmann , Thiago Afonso Teixeira , Barış Saylam , Daniela Delgadillo , Ashok Agarwal

1 Vattikuti Urology Institute
2 Lilavati Hospital and Research Centre
3 Université Ibn Zohr [Agadir]
4 UNIVPM - Polytechnic University of Marche [Ancona, Italy] / Università Politecnica delle Marche [Ancona, Italia]
5 Selçuk University = Selçuk Üniversitesi
6 King Abdulaziz University
7 Minia University
8 Cipto Mangunkusumo Hospital [Jakarta]
9 Loma Linda University
10 Hamad Medical Corporation [Doha, Qatar]
11 Cairo University
12 Weill Cornell Medicine [Qatar]
13 Case Western Reserve University [Cleveland]
14 Apollo Main Hospital [Chennai]
15 Unict - Università degli studi di Catania = University of Catania
16 University Hospital Innsbruck
17 Princess Alexandra Hospital, Brisbane
18 Mansoura University [Egypt]
19 University of Santo Tomas [Manila, Philippines]
20 Southern Illinois University School of Medicine
21 Sohag University
22 PNU - Pusan National University
23 Osaka University [Osaka]
24 Juntendo University
25 Universität Rostock
26 Hôpital Américain de Paris
27 University of Toledo
28 KFSHRC - King Faisal Specialist Hospital and Resarch Centre [Riyadh, Saudi Arabia]
29 Unifg - Università degli Studi di Foggia = University of Foggia
30 Burjeel Hospital
31 Khalifa University
32 OMU - Ondokuz Mayis University
33 Aristotle University of Thessaloniki
34 Molinette Hospital
35 University Hospital Centre Zagreb
36 Ege university
37 Hospital Israelita Albert Einstein [São Paulo, Brazil]
38 Mount Elizabeth Hospital
39 KUGH - Korea University Guro Hospital [ Seoul, Republic of Korea]
40 UCL - Université Catholique de Louvain = Catholic University of Louvain
41 Ministry of Healthcare of Russian Federation - Gynecology and Perinatology Named after Academician V.I. Kulakov [Moscow, Russian Federation]
42 St. Orsola University Hospital
43 Ankara Üniversitesi
44 VNU - Vietnam National University [Hanoï]
45 SQU - Sultan Qaboos University
46 KSU - King Saud University [Riyadh]
47 Hammersmith Hospital NHS Imperial College Healthcare
48 University of Ioannina
49 Fundació Puigvert [Barcelona, Spain]
50 Hospital Clinic Barcelona
51 Niğde Ömer Halisdemir University
52 Udayana University [Bali]
53 Biruni University
54 University of Algiers 1
55 Cleveland Clinic
56 Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
57 Faculty of Medicine [Hacettepe University]
58 Başkent University Hospital [Adana, Turkey]
59 CUHK - The Chinese University of Hong Kong [Hong Kong]
60 Kansai University
61 Taylor’s University
62 SMU - Sefako Makgatho Health Sciences University - Université des sciences de la santé Sefako Makgatho
63 Bahcesehir University [Istanbul]
64 CHI Poissy-Saint-Germain
65 BREED - Biologie de la Reproduction, Environnement, Epigénétique & Développement
66 Molinette Hospital
67 Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
68 Monash University [Melbourne]
69 Ahvaz Jundishapur University of Medical Sciences
70 UnPad - Universitas Padjadjaran = Padjadjaran University
71 IUMS - Iran University of Medical Sciences [Tehran, Iran]
72 UC - University of California
73 Shiraz University - Shiraz University
74 The University of the West Indies
75 Gulhane Training and Research Hospital
76 Alexandria University [Alexandrie]
77 Konya City Hospital [Konya, Turkey]
78 Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany.
79 University of Melbourne
80 PNTUM - Pham Ngoc Thach Medical University [Ho Chi Minh city, Vietnam]
81 NUHS - National University Health System [Singapore]
82 University of Health Sciences [Istanbul, Turkey]
83 Istanbul Medipol University
84 CECOS - Centre d’Études et de Conservation des Œufs et du Sperme [CHU Jean Verdier]
85 Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]

Purpose: 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.

Mots clés: Azoospermia; Hypogonadism; Infertility; male; Semen; Sperm retrieval

Domaines: Biologie de la reproduction

Amarnath Rambhatla, Rupin Shah, Imad Ziouziou, Priyank Kothari, Gianmaria Salvio, et al.. 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. The World Journal of Men's Health, 2024, 42, ⟨10.5534/wjmh.230339⟩. ⟨hal-04569819⟩