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