Testicular biopsy in azoospermia and severe oligozoospermia

The continued experience of testicular biopsy application in 861 cases of azoospermia and 152 cases of severe oligospermia is reported adding to the previously published cases of 1075 patients with azoospermia. The most common finding in the whole series was that of normal testis denoting obstruction (48%), while among cases of functional azoospermia, Sertoli cell only and spermatogenic arrest were the most frequent (66%).     

Testicular sperm extraction and ICSI in patients with post-chemotherapy non-obstructive azoospermia

146 MD-TESE procedures were performed in 74 patients presenting with non-obstructive azoospermia (NOA). Five of the 74 patients displayed a history of chemotherapy. Etiology of chemotherapies included testicular cancer, osteosarcoma, Ewing sarcoma, and malignant lymphoma of the stomach. Post-chemotherapy duration was 2.5-18 years. All patients underwent MD-TESE using local anesthesia with spermatic block and sedation. Extracted sperm was cryopreserved for ICSI. Histopathologic examination revealed Sertoli cell-only syndrome in all five patients; however, sperm were retrieved in 3 subjects. Post-chemotherapy MD-TESE and ICSI can be applied successfully in some patients with NOA. However, freezing semen prior to chemotherapy is recommended.     

Chronic sinopulmonary disease in Chinese patients with obstructive azoospermia

The prevalence of chronic infections of the nasal sinuses and the lung (chronic sinopulmonary disease) was investigated in 33 Chinese patients with obstructive azoospermia who were compared with 32 patients with azoospermia due to failure of the germinal epithelium. Ten out of the group of 33 patients with obstructive azoospermia had congenital absence of the vas and/or epididymis and were excluded from that group. The patients with obstructive azoospermia had normal testis size, normal levels of serum FSH and LH, lower seminal fluid fructose, and a higher incidence of serum sperm agglutinating and immobilizing antibodies when compared with the group with damage to the germinal epithelium. The number of patients with symptoms of chronic sinopulmonary infections were similar in all groups. One patient with obstructive azoospermia had bronchiectasis. All other patients had normal chest x-ray studies. About 40% of the patients in all three groups had abnormal sinus X-rays. However, the nonsmoking patients with obstructive azoospermia had a statistically significant (P less than 0.05) lower mid-expiratory flow rate than the nonsmoking patients with nonobstructive azoospermia. Only three additional patients with obstructive azoospermia had both abnormal sinus x-ray and a reduced mid-expiratory flow rate, suggestive of Young's syndrome. It was concluded that Young's syndrome (sinopulmonary infections associated with acquired obstructive azoospermia) is much less common in Chinese men (four out of 23, 17%) and their sinopulmonary problems are less severe than in Caucasians.     

Electrovasogram in patients with obstructive azoospermia and absent vas deferens

Summary The electric activity of the vas deferens (electrovasogram, EVG) was studied in 22 patients with obstructive azoospermia (OA), in 9 patients with bilaterally absent vasa deferentia, in 10 patients who had undergone epididymovasostomy for OA, and in 12 healthy volunteers (controls). Two electrodes were applied to the posterior aspect of the upper scrotum. EVG in normal subjects showed pacesetter potentials (PPs) that had the same frequency, amplitude, and velocity of conduction from both electrodes and were consistent in the individual subject on all test days. The PPs were followed randomly by action potentials (APs). The EVG in OA exhibited bradyvasa, i.e., diminished PP frequency, amplitude, and velocity, in 14 patients and a silent EVG in 8. Eight of the ten patients in whom azoospermia persisted after epididymovasostomy had a silent EVG. The remaining two patients, whose semen character had normalized after epididymovasostomy, revealed a normal EVG. A silent EVG was recorded for the nine patients with absent vasa deferentia. The electric activity is believed to be responsible for vasal motility. The bradyvasa or silent EVG encountered in OA might be attributable to the arrested function of the vas deferens and resultant vasal inertia. The latter may persist after epididymovasostomy and be responsible for the failure of the semen to normalize, as occurred in eight patients. In conclusion, EVG is a simple, easy, noninvasive, and nonradiologic technique that might be used as a diagnostic tool in the investigation of vas deferens disorders and infertility.     

Prostate cystadenoma presenting with obstructive azoospermia

We report on a case of prostate multilocular cystadenoma presenting with primary infertility and obstructive azoospermia. Our patient is a 36-year-old presenting with primary infertility in addition to mild deep pelvic pain. Semen analysis revealed azoospermia with positive fructose. His prostate-specific antigen was 0.7 ng/dL and his imaging revealed a large multilocular cystic mass with multiple internal enhancing septa. Transrectal ultrasonography-guided aspiration and biopsies revealed a lining of regular low cuboidal cells. Surgical removal was undertaken through a transperitoneal/retroperitoneal approach and pathology was consistent with a prostatic multilocular cystadenoma. Further studies are needed to characterize and classify cystic lesions of the prostate.     

Aetiology of obstructive azoospermia in Chinese infertility patients

To explore the aetiology of obstructive azoospermia (OA) in Chinese infertility patients, 133 OA patients was included in this study diagnosed and evaluated by one major specialist trained urological infertility. We retrospected the medical records to collect relative information. All of the patients had been underwent physical examination, ultrasound scan to the urogenital system, serum hormone tests, genetic tests and two separate semen analyses. The mean age of all 133 patients was 32.7 ± 6.8 years. A total of 266 reproductive tract units (two/patient) were classified into four categories: no causes (Idiopathic) for 74 units (27.8%), single cause for 173 units (65.0%), double causes for 17 units (6.4%) and triple causes for two units (0.8%). As to single cause of OA, there were four types: trauma for 0 unit (0%), infection for 125 units (47.0%), dysplasia for 11 units (4.1%) and surgeries for 37 units (13.9%). As to total cause of OA, there were five types: infection for 144 units (54.1%), orchitis for 51 units (19.2%), epididymitis for 54 units (20.3%), gonorrhoea for 28 units (10.5%) and inguinal hernia repair surgery for 18 units (6.8%). The most frequent cause of obstructive azoospermia was infection revealed in these Chinese infertility populations, followed by idiopathic reason.     

Testicular wedge biopsy for fertility preservation in children at significant risk for azoospermia after gonadotoxic therapy

Background/purposeTesticular tissue cryopreservation (TTC) provides an experimental option for fertility preservation for male children at significant risk for azoospermia owing to high-risk gonadotoxic treatments.MethodsA single institution, retrospective review of TTC cases from 2015 to 2017. Children at significant risk for azoospermia were eligible for study inclusion. A unilateral wedge biopsy of the testis was performed for TTC.ResultsTTC was performed in 23 patients. Average age was 10 years old (5 months to 18 years). Diagnoses included solid tumor (74%, n = 17), hematologic malignancy (17%, n = 4), and benign hematologic disease (13%, n = 3). Six patients had TTC at the time of disease relapse. Nine patients were referred for TTC prior to stem cell transplantation. The majority (70%, n = 16) of patients had an additional procedure at the time of TTC. One patient developed postoperative scrotal cellulitis that was treated with antibiotics. The majority of patients (96%, n = 22) had normal testicular tissue with the presence of germ cells on histopathological analysis. Median time to start of medical therapy was seven days with no unanticipated treatment delays.ConclusionsTesticular wedge biopsy for TTC can be performed safely, coordinated with other necessary procedures, and does not delay the start of treatment. TTC remains an experimental option for fertility preservation for children, as no spermatogenic recovery or pregnancies from cryopreserved testicular tissues have been reported to date.Level of evidenceIV.     

Quality of cryopreserved testicular sperm in patients with obstructive and nonobstructive azoospermia

PURPOSE: Sperm retrieved by testicular sperm extraction is routinely used to attempt pregnancy by in vitro fertilization-intracytoplasmic sperm injection. We evaluated the efficacy of cryopreserving testicular sperm collected by testicular sperm extraction at diagnostic biopsy. MATERIALS AND METHODS: A total of 73 men with obstructive and 42 with nonobstructive azoospermia underwent testicular sperm extraction at diagnostic biopsy. Sperm was retrieved and cryopreserved in all cases of obstruction and in 15 of nonobstructive azoospermia cases. Before freezing we determined sperm count, motility, morphology and viability, and after thawing we assessed sperm motility and viability. In 17 couples a total of 20 cycles of in vitro fertilization-intracytoplasmic sperm injection were performed and fertilization, cleavage and pregnancy rates were determined in cases of obstruction and nonobstruction. RESULTS: Sperm count and morphology were lower in the testicular biopsies of men with nonobstructive versus obstructive azoospermia. Motility was low or absent in all testicular sperm extraction specimens. Importantly, pre-freeze (63%) and post-thaw (31%) viability was the same in both patient groups. After in vitro fertilization-intracytoplasmic sperm injection using frozen and thawed testicular sperm the fertilization, cleavage, implantation and clinical pregnancy rates were 60, 86, 16 and 50%, respectively. Using cryopreserved sperm we observed no differences in outcome of any in vitro fertilization-intracytoplasmic sperm injection procedure in patients with obstructive versus nonobstructive azoospermia. CONCLUSIONS: Cryopreservation of testicular sperm provides enough good quality sperm after thawing to result in excellent in vitro fertilization-intracytoplasmic sperm injection outcomes. Cryopreservation does not adversely affect intracytoplasmic sperm injection outcomes, including pregnancy rate. Therefore, we recommend routine testicular sperm extraction and cryopreservation of sperm at testicular biopsy.     

Testicular sperm extraction in patients with persistent azoospermia after chemotherapy for testicular germ cell tumor

Sperm cryopreservation before chemotherapy in young males is recommended because of chemotherapy's gonadotoxic effects. However, many patients miss sperm banking, and consequently are often sterile. Two azoospermic patients presented to us after chemotherapy, and we obtained sperm from them by testicular sperm extraction (TESE). One patient was 32 years old and had been treated with six cycles of cisplatin, etoposide and bleomycin (BEP) chemotherapy and one cycle of high-dose chemotherapy for stage III non-seminoma. Histopathology of the testicular specimen showed germinal aplasia with focal islands of full spermatogenesis. Although two intracytoplasmic sperm injection (ICSI) cycles were performed, pregnancy was not achieved. The other patient was 33 years old who was treated with four cycles of BEP chemotherapy for stage II seminoma. Histopathology of the testicular specimen showed Sertoli-cell-only syndrome. Ongoing pregnancy was achieved after one ICSI cycle. TESE should be considered in patients with persistent azoospermia after chemotherapy if frozen sperm samples are not available.     

Light and electron microscopic studies of the epididymis in 30 patients with obstructive azoospermia

The epididymal tissue and the testis biopsy from 30 patients with obstructive azoospermia, who had undergone refertilization operations, were investigated by light- and electron microscopy. The findings give an insight into the morphologically recognizable tissue relationships, which one finds in patients with congenital or acquired obstruction of the deferent duct. A severe blockage of the testicular secretion is found in the epithelium of these epididymal ducts and demonstrate considerable pathological tissue changes, which indicate an intense resorptive activity. Intra-luminal spermatophages, which are loaded with phagocytized spermatozoa fragments, penetrate through the epithelium. Also great numbers of monocytes, as well as mast cells, and lymphocytes appear in the interstitium. The autoimmune reaction, induced by the continual blockage of epididymal passage over a long period of time, is discussed.     

附睾或睾丸精子对梗阻性无精子症ICSI治疗结局影响的系统评价

目的:系统评价梗阻性无精子症患者选择附睾精子或睾丸精子行ICSI治疗对其临床结局的影响。方法:通过计算机检索Pub Med、Medline、EMBASE、Cochrane图书馆和CNKI、VIP、CBM、万方数据库建库至2015年12月有关梗阻性无精子症患者采用附睾精子或睾丸精子行ICSI治疗的文献,由2位研究者按照纳入与排除标准进行文献筛选、资料提取和质量评价,并采用Rev Man5.3软件进行meta分析。结果:共纳入14项试验研究,包括梗阻性无精子症患者1 278例,共计1 552个周期。Meta分析结果显示:梗阻性无精子症患者行ICSI治疗,附睾精子比睾丸精子具有更好的受精率[RR=1.08,95%CI(1.05,1.11),P0.01];附睾精子和睾丸精子的卵裂率[RR=1.04,95%CI(0.99,1.10),P=0.13]、优质胚胎率[RR=1.01,95%CI(0.93,1.09),P=0.85]、种植率[RR=1.14,95%CI(0.75,1.73),P=0.55]、临床妊娠率[RR=1.14,95%CI(0.98,1.31),P=0.08]以及流产率[RR=0.86,95%CI(0.53,1.39),P=0.54]差异均无统计学意义。结论:梗阻性无精子症患者行ICSI治疗,附睾精子显示出更高的受精率,而在卵裂率、优质胚胎率、种植率、临床妊娠率以及流产率方面,两者临床结局差异不大。     

梗阻性无精子症患者睾丸精子左旋肉碱培养后关键基因表达量的变化研究

目的:探讨肉碱对人精子活力的影响及其对男性不育的治疗作用。方法:以梗阻性无精子症患者睾丸穿刺取得的精子为研究对象,通过普通培养液、培养液中添加100mmol/L及250mmol/L肉碱进行培养,比较培养前后精子活动率的变化,以及用RT-PCR检测男性生殖细胞特异性基因Vasa、Dazl、Acr、Prm1及ATPase6.0表达量的变化,探讨左旋肉碱与有关精子发生和成熟过程的重要功能基因表达的关系。结果:培养24～72h,添加100mmol/L的左旋肉碱培养液运动精子数明显较未添加和添加250mmol/L组高(P<0.01);100mmol/L左旋肉碱培养液组中典型的快速前向运动精子数明显较多,巴氏染色法观察其具有正常的精子结构,RT-PCR检测表明100mmol/L的肉碱可提高精子中Acr、Prm1、Dazl及ATPase6.0基因的表达量,而250mmol/L的肉碱组Dazl、Acr、Prm1基因的表达减少。结论:合适浓度的左旋肉碱可通过上调一些生殖相关基因的表达使得睾丸精子培养后活力增强,有利于对睾丸穿刺患者行单精子注射时精子的选择。如培养液中肉碱浓度过高,可能由于肉碱的毒性作用,反而使得这些基因的表达量减少。     

A therapeutic experience with alloplastic spermatocele used in obstructive azoospermia

To perform AIH, an artificial spermatocele was inserted into the epididymis for obstructive azoospermia (probably caused by congenital defect of the spermiduct on one side and by accidental vasosection in hernioplasty on the other). The graft used was a cup-shaped alloplastic spermatocele made of silicon-dacron, developed by Wagenknecht et al. The epididymal duct was incised microscopically. The graft was sutured to the epididymal involucrum, punctured through the scrotal skin by an injection needle and aspirated spermatozoa accumulated in the internal cavity, and subjected to AIH. Postoperatively, acceleration of spermatogenesis was attempted by injecting i.m. HCG 2,000 U-HMG 150 U twice a week, but spermatozoa both qualitatively and quantatively sufficient to perform AIH could not be obtained. Spermatozoa were no longer found after two and a half postoperative months. Despite the present failure, we would like to develop a method of grafting of this kind as more precise therapeutic means through further technical improvements in grafting.     

Reconstruction of seminal ducts in obstructive azoospermia

Depending on the localization of the obstruction of the seminal ducts, either a microsurgical reconstruction (tubulovasostomy, vasovasostomy) or a transurethral resection of the ejaculatory ducts is carried out. We have compared the effectiveness and economic advantages of reconstructive microsurgery of the epididymis and vas deferens with standard procedures in animal experiments. Microsurgical invagination techniques in tubulovasostomy are equal to the standard procedure from the point of view of the patency and fertility rates. They are also easier to learn and carry out. Less time is required for the invagination technique, and also less microsurgical suture material. The double-layer technique in vasovasostomy is equal to the one-layer microsurgical technique from the point of view of patency and fertility rates. The one-layer technique requires less time and suture material. It seems that the discrepancy between the patency and the fertility rate is related to immunological processes after reconstruction of the seminal ducts. In cases of obstructive azoospermia it is necessary to investigate the individual conditions and possibilities of the infertile couple. As a result of the high success rate obtainable today by surgical reconstruction of the seminal ducts, this must constitute the first type of treatment to be considered, before any of the procedures of reproductive medicine are undertaken.     

梗阻性无精子症附睾超声声像图特征研究

目的:探讨先天性及后天获得性梗阻性无精子症附睾超声声像图的特征性改变。方法:应用经阴囊超声观察和评估211例梗阻性无精子症患者附睾的异常声像图改变,比较先天性(n=118)及后天获得性梗阻性无精子症(n=93)附睾超声声像图特征的差异。结果:先天性梗阻性无精子症附睾头部回声杂乱伴输出小管扩张、体尾部缺如、体尾部条索样改变、体尾部截断征百分率高于后天获得性梗阻性无精子症,差异有统计学意义(P<0.05)。后天获得性梗阻性无精子症附睾体尾部附睾管细网状扩张、附睾尾炎性团块百分率高于先天性梗阻性无精子症,两者差异有统计学意义(P<0.01)。先天性梗阻性无精子症附睾头、体、尾附睾管状扩张百分率分别为:5.9%(14/236)、17.2%(41/236)、8.4%(20/236),高于后天获得性梗阻性无精子症(P<0.05),后天获得性梗阻性无精子症附睾头、体、尾附睾管细网状扩张的百分率分别为:64.0%(119/186)、76.3%(142/186)、58.6%(109/186),高于先天性梗阻性无精子症(P<0.05)。先天性梗阻性无精子症附睾主要特征为附睾管不规则扩张伴管壁回声减弱且结构欠清(P<0.05),后天性梗阻性无精子症附睾管则呈规则扩张伴管壁回声增强(P<0.01)。结论:先天性及后天获得性梗阻性无精子症附睾超声声像图特征存在明显不同,对于两者鉴别有很大的临床实用价值。     

Testicular fine needle aspiration for sperm retrieval in non-obstructive azoospermia

Objective: To investigate the feasibility of obtaining mature spermatozoa for intracytoplasmic sperm injection (ICSI) by testicular fine needle aspiration (TEFNA) in men diagnosed non-obstructive azoospermia. Methods: TEFNA was performed in 121 patients with a mean of 15 punctures and aspirations from each testis with a #23 butterfly needle connected to a 20 mL syringe with an aspiration handle. Results: One hundred and twenty-one patients underwent 176 TEFNA cycles. Testicular sperm were recovered in 56.3 % (99/176) cycles from 57 % (69/121) of patients. The sperm recovery rate was 46.7 % (21/45) in patients with Sertoli cell-only syndrome, 45.7 % (16/35) in patients with maturation arrest, 96.1 % (25/26) in patients with hypospermatogenesis and 63.6 % (7/11) in patients of non-mosaic Klinefelter's syndrome as judged by testicular histology. No sperm were found in 3 cases with post-irradiation fibrosis and one, after resection and chemotherapy of unilateral testicular cancer. In 87 cycles of ICSI using