No abstract available.
Azoospermia* ; Diagnosis*

Azoospermia is determined when no spermatozoa can be detected on high-powered microscopic examination of a pellet after centrifugation of the seminal fluid. A physician can initially identify the causes of azoospermia by an exhausted history and a complete physical examination. Men with testicular or pretesticular azoospermia should be offered genetic testing and measurement of serum sex hormones to exclude genetic abnormalities or hypogonadism. And the CFTR mutation test should be recommended to exclude the possibility of CF present in the offspring when azoospermia is related to CBAVD or primary epididymal obstruction. Testicular size, inhibin B levels and serum FSH concentration help to evaluate spermatogenesis of the testis, and diagnostic testicular biopsy can further distinguish obstructive causes from testicular failure in case of normal-sized testes. Vasography may be used to identify the site of obstruction, but only when reconstructive surgery is performed.
Azoospermia ; diagnosis ; etiology ; Humans ; Male ; Testis ; pathology

Idiopathic semen quality abnormalities include idiopathic oligozoospermia, asthenospermia, teratospermia, azoospermia and idiopathic abnormal semen liquefaction. The possible causes of idiopathic semen quality abnormality include age, non-inflammatory function changes of subsidiary gonadal organs, infection, genetic abnormalities, sperm mitochondrial changes, effects of environmental pollutants, and subtle hormonal changes. The diagnosis of idiopathic oligozoospermia, asthenospermia, teratospermia and azoospermia require detailed inquiry of the case history, physical examination, semen analysis, determination of reproductive hormones, genetic and immunological examinations, and so on, to exclude possible known causes. The treatment of idiopathic oligozoospermia, asthenospermia, and teratospermia may involve the use of Western medicines, such as clomiphene citrate, tamoxifen, recombinant FSH, Andriol, compound zinc and selenium, L-carnitine, recombinant growth hormone and pentoxifylline, the application of traditional Chinese drugs, or the combination of traditional Chinese and Western medicine. Idiopathic azoospermia can be treated by assisted reproductive technology based on the medication of spermatogenesis-promoting drugs, and idiopathic abnormal semen liquefaction can be managed with traditional Chinese drugs, integrated traditional Chinese and Western medicine, or in vitro semen processing technology. With the development of diagnostic technology, it is expected that more specific therapeutic methods will be established for idiopathic semen quality abnormalities and their incidence will be reduced.
Asthenozoospermia ; diagnosis ; therapy ; Azoospermia ; diagnosis ; therapy ; Humans ; Male ; Oligospermia ; diagnosis ; therapy ; Semen Analysis

OBJECTIVETo detect the levels of seminal plasma leptin (SPL) and serum leptin (SL) in patients with azoospermia, and to explore the methods of using SPL and SL alone or the combination of SPL, SL and follicle stimulating hormone (FSH) for the differential diagnosis of obstructive azoospermia (OA) and non-obstructive azoospermia (NOA).

METHODSWe enrolled in this study 45 patients with diagnosed OA, 41 with unexplained NOA and 30 men with normal semen parameters as controls. The azoospermia patients underwent percutaneous aspiration from the epididymis (PESA) or aspiration/extraction from the testis (TESA/TESE), and all the subjects were detected for the levels of serum FSH, SPL and SL. Individual and multiple indexes were evaluated by Fisher's discriminant analysis combined with ROC curve analysis.

RESULTSThere were no significant differences in the body mass index (BMI) among the three groups. Compared with the normal control, the OA patients showed an obviously elevated level of SPL (P = 0.048), and the NOA patients remarkably increased levels of FSH (P = 0.000), SL (P = 0.000) and SPL (P = 0.000). In comparison with the OA group, the levels of FSH (P = 0.000), SL (P = 0.006) and SPL (P = 0.033) were significantly increased in the NOA group. For the differential diagnosis of OA and NOA, the areas under the ROC curve of SPL and SL were 0.658 (P = 0.014) and 0.702 (P = 0.002) , respectively, both significantly greater than 0.5, while that of the combination of SPL, SL and FSH was the greatest (0.953). In addition, with 0.026 x SPL +0.05 x SL +0.106 x FSH -2.197 as the combined indicator value and -0.289 as the cut-off value (> or = cut-off value for NOA), the sensitivity and specificity of the combination were 0.878 and 0.902, respectively, both reached the maximum.

CONCLUSIONBoth the levels of SPL and SL are valuable for the differential diagnosis of OA and NOA, but the joint consideration of SPL, SL and FSH may provide better indicators.

Adult ; Azoospermia ; blood ; diagnosis ; Case-Control Studies ; Diagnosis, Differential ; Humans ; Leptin ; blood ; Male

OBJECTIVETo investigate the diagnosis and treatment of epididymal obstructive azoospermia (OA) by microsurgery.

METHODSWe performed surgical scrotal exploration for 57 cases of OA whose obstruction was suspected to be in the epididymis. Those confirmed to be epididymal OA cases and with motile sperm in the epididymis underwent longitudinal-2-suture intussusceptive vasoepididymostomy (LIVES). And for those with sperm in the epididymal head only or with bilateral obstruction or absence of the vas deferens in the distal epididymis, the sperm were collected and subjected to cryopreservation for intracytoplasmic sperm injection (ICSI). After surgery, the patients were followed up for observation of the semen parameters and the rate of pregnancy.

RESULTSOf the total number of patients, 53 (92.9%) were diagnosed with epididymal OA by scrotal exploration, 47 (82.5%) underwent microsurgery, and the other 10 (17.5%) received sperm cryopreservation. At 1 to 18 months after surgery, motile sperm were found in the ejaculate in 46.8% of the cases (22/47), natural pregnancy in 10.6% (5/47), and ICSI pregnancy in 18.5% (6/32).

CONCLUSIONWith the development of microsurgery, non-invasive means should be the first choice for the diagnosis of OA. And surgical exploration can be employed to determine the location of obstruction and the option for treatment.

Adult ; Azoospermia ; diagnosis ; surgery ; Epididymis ; surgery ; Humans ; Male ; Microsurgery ; Middle Aged ; Vas Deferens ; surgery

Infertility is a common medical condition which affects nearly 15% of the world population. Non-obstructive azoospermia (NOA) is a most challenging problem inducing male infertility and does not respond to the existing medication. Surgery is the primary method for obtaining sperm from NOA patients, but the outcome of testicular sperm extraction is unpredictable preoperatively. Recently, with the development of detection techniques for male infertility, some new biomarkers have come into notice, which may be of some value in predicting the outcome of microdissection testicular sperm extraction (MTSE) and evaluating male infertility. This article presents an overview of the known biomarkers contributive to the prediction of the outcome of MTSE for NOA patients.
Azoospermia ; Biomarkers ; analysis ; Humans ; Infertility, Male ; diagnosis ; Male ; Microdissection ; Retrospective Studies ; Sperm Retrieval ; Spermatozoa ; Testis

Testicular biopsy is mandatory in azoospermic men with normal sized testes to distinguish between ductal obstruction and spermatogenic failure as the cause of azoospermia. In men with poor semen quality or azoospermia and small testes, the results of a pathologic evaluation will rarely if ever alter therapy. However, the biopsy often assists in making a definitive diagnosis which helps the physician in giving the patient a prognosis and avoiding unnecessary treatment in irredeemable situation. We performed 25 cases of testicular biopsy in infertile men, procuring the results as below: 1. Testicular biopsy specimen were classified into 5 group histopathologically: germ cell aplasia, 6 cases (24%); spermatogenic arrest, 8 cases (32%); hypospermatogenesis, 5 cases (20%); peritubular or tubular fibrosis, 3 cases (12%); normal or obstructive, 3 cases (12%). 2. In 25 cases, 18 cases were azoospermia and 7 cases were oligospermia. 3. In 13 cases (52%), the lesions were localized both in the seminiferous tubule and in the interstitial tissue and in 9 cases (36%), the lesions were localized only in the seminiferous tubule, and 3 cases (12%)were normal.
Azoospermia ; Biopsy* ; Diagnosis ; Fibrosis ; Germ Cells ; Humans ; Infertility ; Infertility, Male* ; Male ; Male* ; Oligospermia ; Prognosis ; Semen Analysis ; Seminiferous Tubules ; Testis

Testicular biopsy is an important tool in the diagnosis and management of male infertility. The increasing use of this procedure has permitted a rational classification of the testicular lesion responsible for infertility and provide an intelligent basis for the institution of corrective measures or the withholding of therapy in cases in which the biopsy indicates a hopeless prognosis for fertility. The testicular biopsy findings of 48 azoospermia cases were evaluated in aspects of testicular size and past history. The following results were obtained. 1. The biopsy findings of 8 cases with normal sized testes and no nodules of both epididymimides and vasa deferens were normal in 4 cases, germinal aplasia in 2 cases, maturation arrest in 1 case and hypospermatogenesis in 1 case. 2. The biopsy findings of 23 cases with small sized testes and no nodules of both epididymides and vasa deferens were germinal aplasia in 13 cases, generalized fibrosis in 6 cases, maturation arrest in 3 cases and hypospermatogenesis in 1 case. 3. The past history of 17 cases with normal sized testes and bilateral induration of epididymides of vasa deferens revealed nonspecific epididymitis in 6 cases, tuberculous epididymides in 6 cases, tuberculous epididymitis in 5 cases, vasectomy in 5 cases and trauma of scrotum in 1 case. The biopsy findings of these cases were normal in 10 cases, hypospermatogenesis in 3 cases, testicular blockage in 3 cases and atrophy in 1 case.
Atrophy ; Azoospermia* ; Biopsy* ; Classification ; Diagnosis ; Epididymitis ; Fertility ; Fibrosis ; Humans ; Infertility ; Infertility, Male ; Male ; Oligospermia ; Prognosis ; Scrotum ; Testis ; Vasectomy

OBJECTIVETo evaluate percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE) in the diagnosis and treatment of azoospermia.

METHODSWe examined 385 azoospermia patients using the techniques of PESA and TESE.

RESULTSOf 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%.

CONCLUSIONPESA 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 ; Azoospermia ; diagnosis ; therapy ; Cell Separation ; methods ; Epididymis ; cytology ; Humans ; Male ; Sperm Injections, Intracytoplasmic ; methods ; Testis ; cytology ; Treatment Outcome

OBJECTIVETo evaluate the quantitative analysis by real-time elastosonography in the differential diagnosis of obstructive azoospermia (OA) and non-obstructive azoospermia (NOA).

METHODSWe evaluated the elastosonographic images of 200 cases of OA, 300 cases of NOA and 100 normal healthy controls, calculated the strain ratio of the testis to the scrotal skin and the median strain ratio among the three groups, and analyzed the best cut-off point for differentiating OA and NOA by the receiver operation characteristic (ROC) curve.

RESULTSThe median strain ratio of NOA was 0.49 +/- 0.43, while that of OA was 0.35 +/- 0.31, with significant difference between the two groups (Z = - 19.173, P = 0.000 < 0.017). According to the results of ROC curve analysis, the area under the curve was 0.857 +/- 0.012 and the best cut-off point for differentiating OA and NOA was 0.395 (sensitivity = 84.5%, specificity = 74.5%, accuracy = 80.5%).

CONCLUSIONQuantitative analysis by real-time elastosonography is a new valuable technique for the differential diagnosis of azoospermia.

Adult ; Azoospermia ; diagnostic imaging ; Case-Control Studies ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Testis ; diagnostic imaging ; Ultrasonography ; methods ; Young Adult