In men with non-obstructive azoospermia caused by primary testicular failure, the problem is sperm production not a blockage.
When sperm are not found in the semen, international guidelines recommend microTESE as the preferred surgical method for retrieving sperm for ICSI.
Hormonal treatments such as hCG may help men with specific hormonal deficiencies. However, in primary testicular failure, evidence that hormonal therapy significantly improves microTESE outcomes remains limited.
The Prolistem strategy begins before surgery.
Prolistem was developed from our research concept at MD Anderson Cancer Center: support the testicular environment and give the remaining sperm-producing cells an opportunity to continue and complete the spermatogenesis cycle.
Our proposed management pathway is:
Six months of Prolistem → regular semen analysis → microTESE if sperm are not found
If sperm appear in the semen, they may be collected and used for ICSI. If no sperm are detected after six months, the patient can proceed to microTESE as the next step.
Prolistem does not guarantee sperm production or retrieval. It provides a new pre-microTESE strategy for selected men with non-obstructive azoospermia.
