Except in cases of hypogonadotropic hypogonadism, the use of medical therapy before microsurgical testicular sperm extraction (micro-TESE) is controversial. In some studies, hormone therapy has been shown to improve the possibility of sperm retrieval during micro-TESE and even lead to the presence of sperm in the ejaculate in some cases, thereby obviating the need for micro-TESE. However, their routine use before micro-TESE in cases of nonobstructive azoospermia (NOA) being associated with hypergonadotropic hypogonadism and eugonadism (normogonadotropic condition) has not been supported with robust evidence. In this review, we discuss different types of medical therapy used before micro-TESE for NOA, their risks and benefits, and the available evidence surrounding their use in this setting.

Sujoy Dasgupta, MS, DNB, MRCOG, MSc is currently working as an IVF-clinician and clinical director at Genome Fertility Centre, Kolkata, India. He has 27 publications cited over 111 times with h-index 4. He has been serving as a peer-reviewer in many journals. He presented his research papers as well as delivered invited lectures in many national and international conferences. He is actively involved in medical education and training programmes. His special interest includes male infertility, PCOS and sexual dysfunction.