O-075 Prevalence and characteristics of idiopathic non-obstructive azoospermia according to the APHRODITE criteria: implications for hormonal optimization therapy
S Esteves, A Achermann, M Viana, R Miyaoka, A F Lozano, J HallakAbstract
Study question
What is the prevalence of idiopathic non-obstructive azoospermia (iNOA) and how many are eligible for hormonal optimization therapy according to the APHRODITE criteria?
Summary answer
According to the APHRODITE criteria, 47% of iNOA patients may qualify for hormonal optimization therapy, which could improve reproductive outcomes in these men.
What is known already
Epidemiological data on iNOA are limited, especially regarding men who might benefit from hormonal optimization therapy before sperm retrieval (SR). The novel APHRODITE criteria (Reprod Biomed Online. 2024;48(4):103647) classify iNOA into four groups based primarily on hormonal and semen parameters, helping identify candidates for hormonal therapy. Previous studies suggest that hormonal optimization may enhance SR success rates, but specific data based on real-world patient populations are scarce. This study contributes to filling that gap.
Study design, size, duration
A cross-sectional analysis was conducted on data from 623 consecutive iNOA patients (aged 24-65) from two tertiary Andrology centers in Brazil.
Participants/materials, setting, methods
Patients underwent comprehensive diagnostic evaluation for NOA and were classified into groups 1 (hypogonadotropic hypogonadism), 2 (idiopathic infertility, normal FSH and T levels), 3 (idiopathic infertility, normal FSH and T < 350 ng/dL), and 4 (idiopathic infertility, elevated FSH levels, and either eugonadal or hypogonadal based on T levels). Descriptive statistics compared characteristics across groups, and SR outcomes in patients naïve to pre-SR hormonal therapy were analyzed. T and FSH levels were measured using established thresholds.
Main results and the role of chance
Prevalence by APHRODITE groups was 3.5% (group 1; n = 22), 14.6% (group 2; n = 91), 35.6% (group 3; n = 222), and 46.2% (group 4; n = 288). Overall, 47.2% (294 patients) met the eligibility criteria for hormonal optimization therapy, defined as serum levels below the upper limit of the normal range for FSH (≤12 IU/L) and LH (≤10 IU/L). By group, eligibility for hormone therapy was 100% (group 1; n = 22), 92.3% (group 2; n = 84), and 69.8% (group 3; n = 201) according to pre-defined criteria. Among men with iNOA of testicular origin (groups 2-4), group 2 and 3 patients had higher testis volume and lower FSH, LH and estradiol than group 4. SR success rates were 33.8% for group 4, compared to 50.9% for group 2 and 52.3% for group 3 (p = 0.005). These findings suggest a potential for improved SR outcomes (groups 2-4) or return of sperm in the ejaculate (group 1) with hormonal therapy in a substantial proportion of iNOA patients.
Limitations, reasons for caution
The study is cross-sectional and observational, so causality cannot be established. Results may be influenced by unmeasured confounding factors.
Wider implications of the findings
This study highlights the prevalence of iNOA according to the APHRODITE criteria, with a significant portion of patients potentially qualifying for hormonal optimization therapy. This could inform clinical strategies for improving fertility outcomes in iNOA patients and pave the way for future research.
Trial registration number
No