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PubMed2000

Expression pattern of germ cell-specific genes in the testis of patients with nonobstructive azoospermia: usefulness as a molecular marker to predict the presence of testicular sperm.

OBJECTIVE: To analyze the expression pattern of testis-specific genes of patients with various spermatogenic defects and their usefulness as a molecular marker to predict the presence of testicular spermatozoa in patients with nonobstructive azoospermia undergoing IVF. DESIGN: Prospective, controlled study. SETTING: Hospital-based infertility research laboratory. PATIENT(S): Fifty-eight men with azoospermia or severe oligozoospermia. INTERVENTION(S): Testicular biopsy was done in the patients with obstructive or nonobstructive azoospermia, including Sertoli cell-only syndrome, maturation arrest, severe hypospermatogenesis, and normal spermatogenesis. MAIN OUTCOME MEASURE(S): Reverse transcriptase polymerase chain reaction was performed using 1 microgram of total RNA extracted from testicular tissues. Three pairs of primers were used for amplification of male germ cell-specific genes (DAZ, transcribed in male germ cells; PGK2, in late spermatocytes and spermatids; protamine-2, in spermatids) as molecular markers. Testicular sperm was obtained by multiple testicular sperm extraction. RESULT(S): The DAZ, PGK2, and protamine-2 genes were expressed in 38, 30, and 21 of the 43 patients with nonobstructive azoospermia, respectively. Testicular spermatozoa were successfully extracted in 4 of 43 patients with nonobstructive azoospermia with the use of multiple testicular sperm extraction. Detection of protamine-2 transcripts predicted the presence or absence of spermatozoa in the testicular tissue in 39 of 43 patients (91%). CONCLUSION(S): Expression of the protamine-2 gene may be a useful molecular marker to predict the presence of testicular sperm in patients with nonobstructive azoospermia.

Adult↗
PubMed2004

[Application of percutaneous epididymal sperm aspiration and testicular sperm extraction to the diagnosis and treatment of azoospermia].

OBJECTIVE: To evaluate percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE) in the diagnosis and treatment of azoospermia. METHODS: We examined 385 azoospermia patients using the techniques of PESA and TESE. RESULTS: Of the total number of the azoospermia patients, 64 (16.62%) had sperm in the epididymis and 45 (11.69%) in the testis. Intracytoplasmic sperm injection (ICSI) was applied to 64 of the patients with sperm in the epididymis or testis. The pregnancy rate after the embryo transfer was 39.07%. CONCLUSION: PESA and TESE, as an effective therapy for azoospermia, can further the classification of azoospermia and provide chances of procreation to azoospermia patients with partial obstruction.

Adult↗
PubMed2006

Techniques for surgical retrieval of sperm prior to ICSI for azoospermia.

BACKGROUND: Azoospermia, the absence of sperm in ejaculated semen, is the most severe form of male factor infertility and is present in approximately 5% of all investigated infertile couples. The advent of intra-cytoplasmic sperm injection (ICSI), however, has transformed treatment of this type of severe male factor infertility. Sperm can be retrieved for ICSI from either the epididymis or the testis depending on the type of azoospermia. OBJECTIVES: To evaluate the efficacy of the various surgical retrieval techniques for men with obstructive or non obstructive azoospermia prior to ICSI. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched 12 Jan 2005), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2004), MEDLINE (1966 to Nov 2004), EMBASE (1980 to Dec 2004), and Biological Abstracts (1980 to Nov 2004) and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the effectiveness of sperm retrieval techniques in men with azoospermia prior to ICSI. Due to the lack of RCTs, non-randomised trials that used the participants as their own control, were also considered in the review but not included in the meta-analysis. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Two trials involving 98 men were included. The first small RCT had 59 participants and compared two epididymal techniques. The trial gave limited evidence that microsurgical epididymal sperm aspiration (MESA) achieved significantly lower pregnancy (One pregnancy in 29 procedures compared with seven pregnancies in 30 procedures, OR 0.19, 95% CI 0.04 to 0.83) and fertilisation rates (OR 0.16, 95% CI 0.05 to 0.48) than the micropuncture with perivascular nerve stimulation technique. The other RCT comparing two testicular techniques in 39 participants gave no statistically significant evidence about the superiority of the ultrasound guided aspiration technique compared to the aspiration technique without ultrasound guidance. TSA with ultrasound resulted in pregnancy in 3 out of 16 participants and TSA without ultrasound in four pregnancies with 23 participants (OR 1.10, 95% CI 0.21 to 5.74) AUTHORS' CONCLUSIONS: There is insufficient evidence to recommend any specific sperm retrieval technique for azoospermic men undergoing ICSI. In the absence of evidence to support more invasive or more technically difficult methods the reviewers recommend the least invasive and simplest technique available. Further randomised trials are warranted, preferably multi-centred trials. The classification of azoospermia as obstructive and non-obstructive appears to be relevant to a successful clinical outcome so a distinction according to the cause azoospermia is important for future clinical trials.

Epididymis↗
PubMed2005

Secondary azoospermia after vasovasostomy.

OBJECTIVES: To determine the frequency of secondary azoospermia after microsurgical vasovasostomy and to determine what factors increase the risk of its occurrence. METHODS: We performed a retrospective review of three surgeons' experience. Patency was defined as the presence of sperm in at least one postoperative semen sample. Transient patency was defined as azoospermia or no motile sperm after previous documentation of motile sperm. RESULTS: A total of 242 patients underwent 245 procedures (233 bilateral, 12 unilateral). The mean patient age was 39.2 +/- 0.4 years (range 24 to 56), and the mean obstructive interval was 8.7 +/- 0.3 years (range 0.25 to 24). The patency rates were 91% (224 of 245, sperm present in the semen) and 86% (208 of 245, motile sperm present in the semen). The transient patency rates were 5.3% (13 of 245, presence of sperm, with subsequent azoospermia) and 2.9% (7 of 241, motile sperm in the semen, with subsequent azoospermia) at a follow-up of 9.0 +/- 0.7 months (range 1 to 60). Transient patency occurred at a mean of 9.7 +/- 2.3 months. A greater risk of transient patency was observed with unilateral cases than bilateral cases (3 of 12, 25% versus 10 of 233, 4.3%; P = 0.0196, Fisher's exact test), and the obstructive interval was shorter for patent than for transient patent cases (Mann-Whitney U test, P = 0.0458). CONCLUSIONS: The results of our study demonstrated that secondary azoospermia after vasovasostomy is rare. It is more common in unilateral cases and the obstructive interval for transiently patent cases is longer. Sperm cryopreservation, when motile sperm appear in the semen postoperatively, can circumvent the problem of secondary azoospermia, but most men will not need the frozen sperm.

Adult↗
PubMed1997

Results of a pilot study of the time to azoospermia after vasectomy in Mexico City.

In a joint pilot study by Family Health International (FHI), AVSC International, and the Instituto Mexicano del Seguro Social (IMSS), information was gathered on the determinants of azoospermia following vasectomy on 38 healthy men who chose vasectomy for contraception. The time and number of ejaculations associated with loss of sperm motility and loss of sperm eosin vital staining were also evaluated. "Azoospermia" was defined on the basis of two consecutive azoospermic semen samples collected at least 3 days apart. The single decrement life table method was used to calculate weekly gross cumulative life table rates for the time to azoospermia, zero motility, and zero viability. The Kaplan-Meier method was used to calculate the product-limit estimates of the cumulative rates for the total number of ejaculations to azoospermia, 0% motility and 0% viability. The median time to azoospermia was 10 weeks and at the end of week 20, the life table rate (+/- standard error) was 93.0 (+/- 6.30) weeks/100 men. The median number of ejaculations to azoospermia was between 25 and 30, and the cumulative rate (+/- standard error) at 60 ejaculations reached 94.5 (+/- 5.16)/100 men.

Adult↗
PubMed2001

Intratesticular Doppler flow, seminal plasma nitrites/nitrates, and nonobstructive sperm extraction from patients with obstructive and nonobstructive azoospermia.

OBJECTIVE: To prospectively evaluate the role of intratesticular vascular flow in modulating sperm function in men with obstructive and nonobstructive azoospermia. The correlation of testicular Doppler values with nitric oxide and testicular sperm extraction was further evaluated. DESIGN: Prospective study. SETTING: Assisted reproduction unit at a university center. PATIENT(S): Twenty-eight men with azoospermia undergoing sperm extraction for intracytoplasmic sperm injection. INTERVENTION(S): Ultrasound and color Doppler scanning of the testes. Testicular sperm retrieval and nitrite/nitrate assay. MAIN OUTCOME MEASURE(S): Doppler analysis of testicular transmediastinal artery, plasma and seminal plasma nitrite/nitrate values, and sperm extraction histopathology. RESULT(S): The pulsatility index (PI) of the transmediastinal artery was higher in patients with nonobstructive azoospermia (PI = 1.40 +/- 0.13) than in those with obstructive azoospermia (PI = 1.09 +/- 0.15; P=.011). Seminal plasma nitrite/nitrate concentrations were more elevated in cases of obstructive azoospermia than in gonadal failure. Unsuccessful sperm recovery was observed in four patients who showed the worst indices of gonadal failure. In this subgroup, a transmediastinal PI value >1.50 was always observed. CONCLUSION(S): Doppler analysis of the transmediastinal artery and nitrite/nitrate seminal plasma concentrations are useful for distinguishing between obstructive and nonobstructive azoospermia and allow the identification of the presence of spermatozoa within the testes.

Adult↗
PubMed2001

Serum inhibin B may be a reliable marker of the presence of testicular spermatozoa in patients with nonobstructive azoospermia.

OBJECTIVE: To establish the predictive value of serum inhibin B levels as an indicator of the presence of testicular spermatozoa in nonobstructive azoospermia, compared with the traditional serum FSH marker. DESIGN: Prospective study. SETTING: Private high-complexity reproductive center with university affiliation. PATIENT(S): Seventy-eight patients with nonobstructive azoospermia, 15 patients with obstructive azoospermia, and 10 fertile volunteers. INTERVENTION(S): Blood samples, testicular sperm extraction, percutaneous epididymal sperm aspiration, and semen collection. MAIN OUTCOME MEASURE(S): Serum levels of inhibin B and FSH and presence of spermatozoa on TESE, PESA, or regular semen analysis. RESULT(S): Patients with nonobstructive azoospermia has significantly higher levels of serum FSH and significantly lower levels of inhibin B. Mean inhibin B serum levels were significantly higher in patients with nonobstructive azoospermia who had spermatozoa on TESE than in those in whom no spermatozoa were found (89.31 +/- 73.24 pg/mL vs. 19.23 +/- 22.34 pg/mL), but mean FSH serum levels did not have similar predictive power (21.37 +/- 12.92 IU/mL vs. 19.27 +/- 10.28 IU/mL). The cut-off level of inhibin B separating both groups, as determined by the receiver-operating characteristic curves, was >53 pg/mL. CONCLUSION(S): Serum inhibin B level seems to be more accurate than serum FSH level in prediction of the presence of testicular spermatozoa in patients with nonobstructive azoospermia.

Biomarkers↗
PubMed2002

Assessment of DNA fragmentation of spermatozoa that were surgically retrieved from men with obstructive azoospermia.

OBJECTIVE: To determine the degree of DNA fragmentation in spermatozoa of men with obstructive azoospermia or anejaculation compared with that of ejaculated spermatozoa from fertile donors. DESIGN: Observational study. SETTING; University Medical Center St. Radboud, Nijmegen. The Netherlands. PATIENT(S): Forty-one patients with obstructive azoospermia or anejaculation and 10 fertile donors. MAIN OUTCOME MEASURE(S): Sperm samples were obtained surgically from the epididymis or testis of men with azoospermia or anejeculation and by ejaculation in fertile patients. DNA fragmentation was analyzed in the total sample and in a motile fraction that was isolated as in routine ICSI procedures. DNA breaks were measured by using the TdT-mediated dUTP nick-end labeling assay. RESULT(S): A higher percentage of cells with DNA breaks was found in men with obstructive azoospermia or anejaculation compared with donors (mean, 18.9% vs. 6.2%). A significant lower degree of DNA fragmentation was observed in the motile fraction from patients compared with donors (0.4% vs. 0.6%). CONCLUSION(S): High percentages of cells with DNA damage were found in sperm samples from men with obstructive azoospermia or anejaculation, but a very low frequency of damage to the DNA was observed in the motile fraction. In an ICSI setting, the use of motile sperm retrieved from epididymis or testis of men with obstructive azoospermia does not seem to pose a higher genetic risk to the progeny than does use of motile ejaculated sperm.

DNA Fragmentation↗
PubMed1998

Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia.

OBJECTIVE: To characterize treatment outcome after varicocele repair in men with azoospermia and severe oligoasthenospermia. DESIGN: Prospective nonrandomized study. SETTING: University-based medical center. PATIENT(S): Seventy-eight men with a palpable varicocele and absolute azoospermia (n = 22) or severe oligoasthenospermia (n = 56). INTERVENTION(S): Microsurgical varicocelectomy. MAIN OUTCOME MEASURE(S): Sperm count and pregnancy rate. RESULT(S): Twelve (55%) of the 22 men with azoospermia and 35 (69%) of the 51 men with zero motile sperm before surgery had motile sperm observed in their ejaculate after varicocele repair. The total number of motile sperm per ejaculate increased from 0.08 +/- 0.02 x 10(6) before varicocelectomy to 7.2 +/- 2.3 x 10(6) afterward. Twenty-four men (31%) contributed to pregnancies leading to live births (15 unassisted [19%]), including 3 men with azoospermia preoperatively. CONCLUSION(S): Varicocele repair resulted in the induction or enhancement of spermatogenesis for most men with azoospermia or severe oligoasthenospermia. Unassisted pregnancies after varicocele repair in men with profound abnormalities of spermatogenesis are possible. Varicocele repair should be considered for all men with azoospermia and severe oligoasthenospermia.

Female↗
PubMed2003

Testicular and epididymal percutaneous sperm aspiration in men with either obstructive or nonobstructive azoospermia.

OBJECTIVES: To investigate our experience with epididymal and testicular sperm obtained by percutaneous aspiration to determine the effectiveness of these procedures in patients with obstructive or nonobstructive azoospermia. We also report on the pooled outcome of intracytoplasmic sperm injection, performed at six in vitro fertilization centers, using sperm from these two patient populations. METHODS: A method of percutaneous aspiration of sperm was developed to facilitate diagnostic biopsy and therapeutic aspiration. A total of 265 aspirations were performed for diagnostic and therapeutic purposes from August 1995 through July 2001. RESULTS: Mature sperm were found in 34 (47%) of 73 men with nonobstructive azoospermia, who underwent testicular sperm aspiration for diagnostic purposes. In 56 procedures for men with nonobstructive azoospermia who underwent testicular sperm aspiration for intracytoplasmic sperm injection, an adequate number of viable sperm was obtained from 46 (82%), with an oocyte fertilization and clinical pregnancy rate of 55% and 44%, respectively. In men with obstructive azoospermia who underwent percutaneous epididymal sperm aspiration, viable sperm were found in 91 (97%) of 94 procedures, with an oocyte fertilization and clinical pregnancy rate of 58% and 39%, respectively. Sperm were obtained in 18 (100%) of 18 procedures in men with obstructive azoospermia who underwent testicular sperm aspiration, with a corresponding fertilization and clinical pregnancy rate of 51% and 38%, respectively. A small (less than 1 cm in diameter) subcapsular hematoma was the only complication. CONCLUSIONS: Percutaneous aspiration of sperm is an effective, safe, and reproducible means of obtaining adequate sperm for diagnosis or intracytoplasmic sperm injection in patients with obstructive or nonobstructive azoospermia. Our experience indicates that similar results can be obtained in both patient groups.

Adult↗
PubMed2001

Study of microdeletions in the Y chromosome of infertile men with idiopathic oligo- or azoospermia.

PURPOSE: To determine the relationships between idiopathic oligo- or azoospermia and microdeletions of the Y chromosome. METHODS: Eighteen Y-linked sequence-tagged sites (STSs) in AZF (Azoospermia Factor) region were screened by means of multiplex PCR (Polymerase Chain Reaction) in 50 idiopathic infertile men, including 16 patients with azoospermia, 13 severe oligospermia, and 21 oligospermia. RESULTS: Microdeletions in the genomic DNA were observed in 8 of 50 cases, 3 with azoospermia, I severe oligospermia, and 4 oligospermia. Total deletion rate was 16.0% (8/50). The deletion regions were concentrated on AZFd and AZFc. CONCLUSIONS: Microdeletions of the Y chromosome are an important cause for idiopathic oligo- or azoospermia. Multiplex PCR is a useful technique for detecting the microdeletions. To avoid transmission to their offspring, patients with idiopathic oligo- or azoospermia should be screened for microdeletions of the Y chromosome before ICSI treatment for infertility.

Adult↗
PubMed2006

[Induction of spermatogenesis in patients with non-obstructive azoospermia after antegrade sclerotherapy].

PURPOSE: The aim of this study was to prove the efficacy of antegrade sclerotherapy for varicocele testis in patients with azoospermia and in patients with cryptozoospermia (less than 0.1 million spermatozoons/mL ejaculate). We have investigated the induction of spermatogenesis in patients with non-obstructive azoospermia after antegrade sclerotherapy. MATERIALS AND METHODS: 20 consecutive patients who had been trying to beget a child over a period of one year or longer were chosen for this study. All patients suffered from non-obstructive azoospermia or from cryptozoospermia. We produced a control spermiogram for each patient before, 3 and 6 months after antegrade sclerotherapy. The postoperative spermiogram was done according to WHO criteria and was then compared to the preoperative data. RESULTS: 15 patients (75 %) were found to suffer from azoospermia preoperatively and 5 patients (25 %) from cryptozoospermia. Out of the 15 patients with initial azoospermia 8 (53 %) showed cryptozoospermia (OAT/OT syndrome) after antegrade sclerotherapy. Out of the 5 patients with the initial cryptozoospermia 3 (60 %) showed an improvement in the sperm count and motility criteria. CONCLUSIONS: Antegrade sclerotherapy for varicocele testis is a valid treatment option to isolate the spermatozoons from the ejaculate for extracorporeal fertilisation in patients with non-obstructive azoospermia. Complete normalisation of the spermiogram parameters, i.e., sufficient for natural child conception, cannot safely be achieved by this method.

Adult↗
PubMed1997

The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection.

Factors other than spermatozoa could be the major determinant of the success of assisted reproduction treatment in cases of male infertility. Our aim was to evaluate the effect of the wife's age and ovarian reserve on assisted reproduction success rates in the most severe type of male infertility, i.e. azoospermia. A total of 249 consecutive couples suffering from male infertility caused by azoospermia underwent microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI). Of these men, 186 had irreparable obstructive azoospermia, and 63 had non-obstructive azoospermia due to testicular failure. Neither the pathology, the source, the quantity, nor the quality of spermatozoa had any effect on fertilization or pregnancy rates. Maternal age and ovarian reserve (number of eggs) had no effect on fertilization or embryo cleavage, but did dramatically affect the embryo implantation, pregnancy and delivery rates. Wives of azoospermic men who were in their 20s had a 46% live delivery rate per cycle, wives aged 30-36 years had a 34% live delivery rate per cycle, wives aged 37-39 years had a 13% live delivery rate per cycle, and wives > or = 40 years had only a 4% live delivery rate per cycle. The number of eggs retrieved also affected pregnancy and delivery rate, but to a lesser extent than age. In virtually all cases of obstructive azoospermia, and in 62% of cases with non-obstructive azoospermia caused by germinal failure, sufficient spermatozoa could be retrieved to perform ICSI, with normal fertilization and embryo cleavage. However, the pregnancy rate and the live delivery rate were dependent strictly on the age of the wife, and on her ovarian reserve. Unfortunately, exaggerated claims of high pregnancy rates can thus easily be made by manipulating, in a very simple way, selection for female factors.

Adult↗
PubMed1997

Intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia.

We compared the results of intracytoplasmic sperm injection (ICSI) in: (i) obstructive versus non-obstructive azoospermia, (ii) obstructive azoospermia using epididymal versus testicular spermatozoa and (iii) acquired versus congenital obstructive azoospermia due to congenital absence of the vas deferens (CAVD). A retrospective analysis was done of 241 consecutive ICSI cycles done in 103 patients with non-obstructive azoospermia and 119 patients with obstructive azoospermia. In the obstructive group, 135 ICSI cycles were performed. Epididymal spermatozoa were used in 44 cycles and testicular spermatozoa in 91 cycles. In the non-obstructive group, 106 cycles were performed. The fertilization and pregnancy per cycle rates were 59.5 and 27.3% respectively using epididymal spermatozoa, 54.4 and 31.9% respectively using testicular spermatozoa in obstructive cases, and 39 and 11.3% respectively in non-obstructive cases. The fertilization and pregnancy per cycle rates were 56.6 and 37% respectively in acquired obstructive cases, and 55.2 and 20.4% respectively in CAVD. In conclusion, ICSI using spermatozoa from patients with acquired obstructive azoospermia resulted in significantly higher fertilization and pregnancy rates as compared to CAVD and non-obstructive cases.

Epididymis↗
PubMed2000

Beyond the clinical classification of azoospermia: opinion.

There is an ongoing debate regarding the appropriate classification of azoospermia. This manuscript reviews the rationale for the current classification of azoospermia and how to effect a change if there is a need to do so. The current classification of azoospermia into obstructive and non-obstructive is because azoospermia due to ejaculatory duct dysfunction and hypogonadotrophism are extremely rare. Though the use of clinical protocols (defective spermatogenesis, genital tract obstruction, ejaculatory duct dysfunction, hypogonadotrophism or pre-testicular, testicular and post-testicular) may be useful in selecting patients for appropriate treatment, no study has shown that they provide a better method of classification of azoospermia than the current approach. There is increasing evidence of a genetic basis of male infertility as well as the evidence that men's fertility potential may be classified genetically. Moreover, genetic disorders may be transmitted to the offspring and their presence in infertile couples may affect treatment outcome. It is therefore useful to explore a genetic classification of azoospermia.

Clinical Protocols↗
PubMed1992

Clinical and laboratory findings associated with actual or suspected azoospermia in dogs: 18 cases (1979-1990).

Eighteen dogs were evaluated for azoospermia, 8 of which had sired pups. On the basis of history, physical examination, and various laboratory evaluations, the cause and site of azoospermia varied. Two dogs that had never sired pups had likely been azoospermic from puberty (congenital azoospermia). Two dogs were azoospermic as a result of tumors (Sertoli cell tumor and malignant astrocytoma of the pituitary gland). Deposits of IgG were observed in testicular biopsy samples, which suggested an auto-immune cause for azoospermia in 5 dogs. One of the 5 dogs with IgG deposits in testicular tissues also had evidence of immune-mediated thyroiditis. Culturing of microbes in the semen was not helpful in determining potential causes of azoospermia, and results did not correlate with organisms isolated from testicular biopsy samples or with the finding of inflammation in biopsy samples. Because 6 dogs had relatives with histories of reproductive dysfunction, inbreeding also must be considered when evaluating dogs for azoospermia.

Alkaline Phosphatase↗
PubMed1996

[Excretory azoospermia: contribution of exploratory and curative surgery. Apropos of a follow-up of 33 patients].

Thirty-three patients with azoospermia of apparently excretory origin underwent surgery for epididymis-deferens anastomosis and/or epididymal sperm puncture. Pathology examinations of the epididymal fluid and biopsies of the testicles or epididymis were performed at surgery. Based on the clinical presentation, sperm results and per-operative findings, patients were divided into six groups by etiology: idiopathic azoospermia (n = 5), post-infectious azoospermia (n = 15), agenesia of the excretory (n = 6) or secretory (n = 3) ducts, vasectomy (n = 2), and obstruction of the ejaculatory ducts (n = 2). Peroperative identification of spermatozoa at epididymal puncture or biopsy was statistically more frequent in patients with agenesis of the excretory ducts than in patients with post-infectious or idiopathic azoospermia. Biopsies of the testicle led to the diagnosis of secretory azoospermia in 3 cases and revealed a functional parenchyma in all the other groups of patients. Epididymis-deferens anastomosis was performed in 45% of the cases and was successful in 13%. Rate of fertility with the intracytoplasmic sperm injection was 33%; there was no difficulty in using fresh or frozen sperm. Clinical pregnancy was continued to term with frozen sperm. This study confirms that testicular function is preserved in excretory azoospermia. With or without epididymis-deferens anastomosis, epididymal spermatozoa can generally be preserved for later use. Couples should however be counselled on the delays to contraception which may vary from months to years.

Adult↗
PubMed2006

Chromosomal abnormality and Y chromosome microdeletion in Chinese patients with azoospermia or severe oligozoospermia.

Chromosomal abnormality and Y chromosome microdeletion are regarded as two frequent genetic causes associated with spermatogenic failure in Caucasian population. To investigate the distribution of the two genetic defects in Chinese patients with azoospermia or severe oligozoospermia, karyotype analysis by G-banding was carried out in 358 idiopathic infertile men, including 256 patients with azoospermia and 102 patients with severe oligozoospermia, and screening of AZF region microdeletion of Y chromosome by multiplex PCR was performed in those patients without detectable chromosomal abnormality and 100 fertile controls. Of 358 patients, 39(10.9%) were found to have chromosomal abnormalities in which Klinefelter's syndrome (47, XXY) was the most common chromosomal aberration. The incidence of sex chromosomal abnormality in patients with azoospermia was significantly higher than that in patients with severe oligozoospermia (12.1% vs 1%). Among the rest of the 319 patients with normal karyotype, 46 (14.4%) were found to have microdeletions in AZF region. The prevalence rates of AZF microdeletion was 15% and 13.1% in patients with azoospermia and severe oligozoospermia respectively. The microdeletion in AZFc was the most frequent deletion and all the microdeletions in AZFa were found in azoospermic patients. No microdeletion in AZF region was detected in fertile controls. In conclusion, chromosomal abnormality and AZF region microdeletion of Y chromosome might account for about 25% of Chinese infertile patients with azoospermia or severe oligozoospermia, suggesting the two abnormalities are important genetic etiology of spermatogenic failure in Chinese population and it is essential to screen them during diagnosis of male infertility before in vitro assisted fertilization by introcytoplasmic sperm injection.

Adult↗