Intratesticular autologous platelet-rich plasma injection in couples with nonobstructive azoospermia: a narrative review

Abstract

Azoospermia is the most severe form of male factor infertility presenting approximately 1% of the male population and 5%–10% of infertile men. Azoospermia is classified into two categories: obstructive azoospermia and nonobstructive azoospermia (NOA). Currently, microdissection testicular sperm extraction (mTESE) is still the primary approach especially for cases with NOA. However, there are still some patients with NOA in whom sperm cannot be yielded even after repeated mTESE attempts. Besides, no definitive alternative treatments exist, prompting ongoing research into new approaches for restoring spermatogenesis in patients with NOA. This review focuses on the current literature regarding the possible role of intratesticular autologous platelet-rich plasma (PRP) injection in couples with NOA. First, we give an overview of the pathophysiology of azoospermia and the sperm retrieval techniques in azoospermia. Subsequently, we give information about PRP and briefly discuss the role of PRP on the ovaries and endometrium in the light of literature. Finally, we review the current literature on the testicular administration of PRP on animal models and on human. As a conclusion, the findings of the present review suggests that autologous PRP therapy shows promise as a novel approach in male factor infertility, especially for patients with NOA. Nevertheless, additional investigation through randomized controlled trials is necessary to refine the technique and determine its effectiveness to answer the question of whether PRP could significantly improve the second attempt retrieval rate after a failed previous mTESE procedure.