L26/P-025 The effect of glycyrrhizic acid supplementation in non-obstructive azoospermic men with history of repeated unsuccessful surgical microscopic testicular sperm extraction (mTESE)

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Study question</jats:title> <jats:p>Does glycyrrhizic acid, shown to decrease testosterone levels by inhibiting type 3 17β-hydroxysteroid dehydrogenase, facilitate spermatogenesis in men with non-obstructive azoospermia (NOA)?</jats:p> </jats:sec> <jats:sec> <jats:title>Summary answer</jats:title> <jats:p>Three months of glycyrrhizic acid (84 mg/day), followed by antioxidants, restored spermatogenesis in some NOA men after failed mTESE, enabling motile sperm detection and pregnancies.</jats:p> </jats:sec> <jats:sec> <jats:title>What is known already</jats:title> <jats:p>Outcomes for men with non-obstructive azoospermia (NOA) after repeated unsuccessful mTESE procedures are poor, with very low success rates on subsequent attempts. No evidence-based pharmacological therapies are currently recommended to restore spermatogenesis or improve sperm retrieval in this challenging group of patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Study design, size, duration</jats:title> <jats:p>This retrospective analysis included 29 men with NOA who received glycyrrhizic acid (84 mg daily), omega-3, and B-vitamin complex (Prolistem, Texas, USA) for 6 months at a single assisted reproduction center. All participants had a history of at least two failed mTESE procedures under microscope with no sperm retrieval.</jats:p> </jats:sec> <jats:sec> <jats:title>Participants/materials, setting, methods</jats:title> <jats:p>All men underwent post-treatment semen analysis. If no spermatozoa were detected in ejaculate, a repeat mTESE was performed.</jats:p> </jats:sec> <jats:sec> <jats:title>Main results and the role of chance</jats:title> <jats:p>Mean age was 32.2 ± 5.0 years, mean infertility duration 7.5 ± 1.5 years, and mean number of prior mTESE procedures 2.3 ± 0.46. Baseline mean FSH, LH, and testosterone levels were 27.6 ± 14.0 IU/L, 13.2 ± 8.2 IU/L, and 3.3 ± 1.7 ng/dL, respectively. Post-treatment semen analysis revealed live spermatozoa in 3 out of 29 men (10.3%). Of the remaining 26 men, 13 (50%) opted for repeat mTESE, with successful sperm retrieval in 3/13 (23%). Two ongoing pregnancies (66.7%) were achieved following embryo transfer from ejaculated spermatozoa of the 3 men, and one ongoing pregnancy (33.3%) from testicular spermatozoa of the 3 men. No adverse reactions were reported during the 6-month treatment course.</jats:p> </jats:sec> <jats:sec> <jats:title>Limitations, reasons for caution</jats:title> <jats:p>The sample size is small, and not all participants underwent repeat mTESE, which may introduce selection bias and limit generalizability. The study is retrospective and lacks a control group.</jats:p> </jats:sec> <jats:sec> <jats:title>Wider implications of the findings</jats:title> <jats:p>Glycyrrhizic acid and antioxidant supplementation appears promising as a non-invasive option for NOA men with prior unsuccessful mTESE. Larger prospective, randomized controlled trials are essential to confirm efficacy, optimal dosing, and long-term safety.</jats:p> </jats:sec> <jats:sec> <jats:title>Trial registration number</jats:title> <jats:p>No</jats:p> </jats:sec>