Azoospermia accounted for 10-15% of infertility cases. It is classified into 2 groups: obstructive and non-obstructive azoospermia. Infertility couples due to azoospermia can be treated by some assisted reproductive techniques, such as epididymal sperm aspiration (MESA and PESA techniques), testicular sperm aspiration (TESA) or testicular sperm extraction (TESE). The success can be expected for cases with obstructive azoospermia.
Infertility ; Oligospermia ; Infertility, Male

OBJECTIVE: Azoospermia owing to testicular disorders is the most severe manifestation of male infertility. The main concern for patients with nonobstructive azoospermia (NOA) is the probability of successful sperm retrieval following testicular sperm extraction (TESE). Therefore, the goal of this study was to determine predictive factors correlated with sperm retrieval. METHODS: We assessed the testicular histopathological patterns, the choice of TESE surgical procedure, hormone levels, and chromosomal abnormalities in patients with NOA (n=170). The histopathology specimens were analyzed based on the histopathological patterns of hypospermatogenesis, maturation arrest, and Sertoli cell-only syndrome. RESULTS: The mean rate of sperm retrieval was 48.8%. The rate of sperm retrieval was significantly higher in the hypospermatogenesis group than in the other groups (p<0.001). There was a positive correlation between micro-TESE (vs. conventional TESE) and the sperm retrieval rate (odds ratio, 8.077; p<0.01). A logistic regression model demonstrated that high levels of follicle-stimulating hormone (FSH) and small testicular volume were significantly associated with lower chances of successful sperm retrieval. CONCLUSION: Some parameters, including testicular histopathology patterns, FSH levels, testicular volume, and method of TESE surgery, may be able to predict the chances of obtaining spermatozoa in patients with NOA. However, despite the efficiency of some predictive models, the hope of retrieving any functioning spermatozoa may be sufficient to disregard predictive factors of the success of intracytoplasmic sperm injection in these patients.
Azoospermia* ; Chromosome Aberrations ; Follicle Stimulating Hormone ; Hope ; Humans ; Infertility, Male ; Logistic Models ; Male ; Methods ; Oligospermia ; Pathology ; Sertoli Cell-Only Syndrome ; Sperm Injections, Intracytoplasmic ; Sperm Retrieval* ; Spermatozoa*

OBJECTIVE: To assess whether the “testicular pool” could be used for histological analysis and whether it gave more accurate information than the standard testicular biopsy. METHODS: Between January 2017 and March 2018, this single-center prospective study included 60 azoospermic men undergoing conventional bilateral testicular sperm extraction. Six samples were excised from each testicle and transferred to an embryologist. One additional biopsy was randomly taken from each testis for a histological analysis. After processing, the testicular pool was also sent for a histological analysis, which showed normal spermatogenesis (NS), hypospermatogenesis (HYPO), maturation arrest (MA), Sertoli cell-only syndrome (SCOS), and tubular atrophy (TA). RESULTS: Twenty of the 60 patients (33.3%) had obstructive azoospermia (OA), while the remaining 40 (66.6%) had nonobstructive azoospermia. Their mean age was 40.5 years. All patients with OA had previously undergone unsuccessful testicular fine-needle aspiration. Successful sperm retrieval (SSR) occurred in 93.3% of patients. Histological analysis of the testicular biopsy revealed NS in 12 patients (20%), HYPO and TA in 28 patients (46.6%), MA in eight patients (13.3%), and SCOS in 12 patients (20%). The testicular pool analysis showed NS in 12 patients (20%), HYPO and TA in 44 patients (73.3%), MA in four patients (6.6%), and SCOS in no patients. In four patients with MA (6.6% of the total sample) and 12 patients with SCOS (20% of the total sample) according to the standard testicular biopsy, the embryologist found SSR with cryopreservation. Overall, in 44 patients (73.3%), the testicular pool analysis confirmed the histological findings of the standard testicular biopsy. In the 16 cases (26.6%) with a discrepancy between the single-biopsy histological findings and SSR, the testicular pool analysis confirmed the embryological data on SSR. CONCLUSION: The testicular pool proved to be easily analyzable, practical, manageable, and more accurate for predicting sperm retrieval than standard testicular biopsy.
Atrophy ; Azoospermia* ; Biopsy ; Biopsy, Fine-Needle ; Cryopreservation ; Humans ; Infertility, Male ; Male ; Methods* ; Oligospermia ; Prospective Studies ; Sertoli Cell-Only Syndrome ; Sperm Retrieval ; Spermatogenesis ; Spermatozoa* ; Testis

Spermatogenesis is regulated by several Y chromosome-specific genes located in a specific region of the long arm of the Y chromosome, the azoospermia factor region (AZF). AZF microdeletions are the main structural chromosomal abnormalities that cause male infertility. Assisted reproductive technology (ART) has been used to overcome natural fertilization barriers, allowing infertile couples to have children. However, these techniques increase the risk of vertical transmission of genetic defects. Despite widespread awareness of AZF microdeletions, the occurrence of de novo deletions and overexpression, as well as the expansion of AZF microdeletion vertical transmission, remains unknown. This review summarizes the mechanism of AZF microdeletion and the function of the candidate genes in the AZF region and their corresponding clinical phenotypes. Moreover, vertical transmission cases of AZF microdeletions, the impact of vertical inheritance on male fertility, and the prospective direction of research in this field are also outlined.
Humans ; Male ; Azoospermia/genetics* ; Sex Chromosome Aberrations ; Prospective Studies ; Chromosome Deletion ; Chromosomes, Human, Y/genetics* ; Infertility, Male/genetics* ; Sertoli Cell-Only Syndrome/genetics* ; Oligospermia/genetics*

We analyzed testicular biopsies in eighty five infertile men with seventy eight azoospermia and seven severe oligospermia (< 1000000/ml) at our hospital from January 1989 to July 1993. The testicular volume was average 15.7ml (10 to 20ml). The most frequent histopathological finding was Sertoli cell only syndrome with 25 cases (29.4%). The second prevalent finding was sloughing and disorganization of germ cells with 22 cases (25.9%) and followed by maturation arrest with 19 cases (22.4%) and hypospermatogenesis with 19 cases (22.4%), in order. In the Sertoli cell only syndrome, sloughing and disorganization of germ cells and maturation arrest, nearly all showed azoospermia in the sperm count comparing to the hypospermatogenesis. Leydig cell abnormalities were hyperplasia in 32 cases (37.6%) and hypoplasia in 4 cases (4.7%). On the aspect of feedback, in Sertoli cell only syndrome and maturation arrest, serum FSH was increased in 21 cases (84.0%) and 7 cases (36.8%), respectively, but in the majority of sloughing and disorganization of germ cells and hypospermatogenesis, not increased. Plasma LH, prolactin, testosterone and estradiol were not correlated with germ cell morphology. Therefore, the testicular biopsy is especially important for aid in the diagnosis and prognosis in the infertile men, and further more to evaluate the testicular paracrinology.
Azoospermia ; Biopsy* ; Diagnosis ; Estradiol ; Germ Cells ; Humans ; Hyperplasia ; Infertility ; Male ; Oligospermia ; Plasma ; Prognosis ; Prolactin ; Sertoli Cell-Only Syndrome ; Sperm Count ; Testosterone

OBJECTIVES: To estimate the frequency of Y chromosome microdeletions in the Korean population of infertile men and to evaluate the relationship between microdeletion on the Y chromosome and clinical phenotypes of infertile men with idiopathic azoospermia and oligozoospermia. MATERIALS AND METHODS: Genomic DNA was extracted from blood samples collected from 330 infertile men attending the Infertility Clinic at Samsung Cheil Hospital, Korea. Six sequence tagged sites (STSs) spanning the azoospermia factor (AZF) regions of the Y chromosome were amplified by polymerase chain reactions (PCRs). RESULTS: Microdeletions on Y chromosome were detected in 35 (10.6%) of the 330 infertile men. Most of the microdeletions (91.4%) involved AZFb or AZFc. The high incidence of microdeletions were found in AZFc region (57.1%), but the low in AZFa (8.6%) and AZFb (5.7%). Larger microdeletions involving two or three AZF regions were detected in 28.6% of cases. All patients (6 patients) with deletion of AZFa region showed no germ cell phenotypes, Sertoli cell only syndrome or Leydig cell hyperplasia in histopathologic examinations. CONCLUSION: Microdeletions on the Y chromosome, especially, at AZFc/DAZ regions may be the major cause of azoospermia and severe oligozoospermia. We suggest that idiopathic infertile men have genetic counselling and microdeletion analysis on the Y chromosome before IVF-ET and ART program.
Azoospermia ; DNA ; Germ Cells ; Humans ; Hyperplasia ; Incidence ; Infertility ; Korea ; Male ; Oligospermia ; Phenotype ; Polymerase Chain Reaction ; Sequence Tagged Sites ; Sertoli Cell-Only Syndrome ; Spermatogenesis* ; Y Chromosome*

OBJECTIVES: To estimate the frequency of Y chromosome microdeletions in the Korean population of infertile men and to evaluate the relationship between microdeletion on the Y chromosome and clinical phenotypes of infertile men with idiopathic azoospermia and oligozoospermia. MATERIALS AND METHODS: Genomic DNA was extracted from blood samples collected from 330 infertile men attending the Infertility Clinic at Samsung Cheil Hospital, Korea. Six sequence tagged sites (STSs) spanning the azoospermia factor (AZF) regions of the Y chromosome were amplified by polymerase chain reactions (PCRs). RESULTS: Microdeletions on Y chromosome were detected in 35 (10.6%) of the 330 infertile men. Most of the microdeletions (91.4%) involved AZFb or AZFc. The high incidence of microdeletions were found in AZFc region (57.1%), but the low in AZFa (8.6%) and AZFb (5.7%). Larger microdeletions involving two or three AZF regions were detected in 28.6% of cases. All patients (6 patients) with deletion of AZFa region showed no germ cell phenotypes, Sertoli cell only syndrome or Leydig cell hyperplasia in histopathologic examinations. CONCLUSION: Microdeletions on the Y chromosome, especially, at AZFc/DAZ regions may be the major cause of azoospermia and severe oligozoospermia. We suggest that idiopathic infertile men have genetic counselling and microdeletion analysis on the Y chromosome before IVF-ET and ART program.
Azoospermia ; DNA ; Germ Cells ; Humans ; Hyperplasia ; Incidence ; Infertility ; Korea ; Male ; Oligospermia ; Phenotype ; Polymerase Chain Reaction ; Sequence Tagged Sites ; Sertoli Cell-Only Syndrome ; Spermatogenesis* ; Y Chromosome*

Electron microscopic observation of fine structural changes of Sertoli cells in the male sterility patients was made on 10 histologically proved cases. They were histologically classified to 3 groups by Nelson's classification, hypospermatogenesis, spermatogenic arrest and germinal cell aplasia. The results obtained were summarized as follows. l) The findings of ultrastructures of Sertoli cells in the normal man showed no significant differences with other author's results. 2) The ultrastructures of Sertoli cells in the male sterility revealed degenerative changes, characterized by fragmentation and dilatation of subsurface cisternae, swelling and vacuolization of mitochondria with decrease in the number of cristae and poor development of Golgi apparatus. And also observed were proliferative changes, characterized by increase in the number of sER, rER and ribosome. These morphological changes were severer in spermatogenic arrest and the severest in germinal cell aplasia. 3) The results were suggested that the most significant ultrastructural changes of Sertoli cells of male sterility were the degenerative changes of the organelles of protein synthesis and protein transport system such as rER, ribosome and Golgi apparatus.
Classification ; Dilatation ; Golgi Apparatus ; Humans* ; Infertility ; Infertility, Male* ; Male ; Male* ; Mitochondria ; Oligospermia ; Organelles ; Protein Transport ; Ribosomes ; Sertoli Cell-Only Syndrome ; Sertoli Cells*

For the evaluation and management of male infertility, measurements of testicular size (volume) and plasma hormones (FSH, LH and testosterone) have been considered as very important procedures besides the routine examinations of history, physical examination, laboratory works including semen analyses and testicular biopsy and special studies. A total of 99 infertile males with small testes which were less than 1Oml in volume was subjected to the assessment of plasma FSH, LH and testosterone levels. They were divided into 6 study groups; such as Group I. Control: 28 men with normal semen parameters and plasma hormone values. Group II. Oligospermia: 12 patients with sperm density of less than 20 X 10 6/ml. Group III. Testicular azoospermia: 22 patients with testicular biopsy of better than germ cell arrest. Group IV Sertoli cell only syndrome: 25 patients proved by testicular histology. Group V. Klinefelter`s syndrome: 30 patients proved by karyotype studies. Group VI. Eunuchoidism: 10 patients proved by laboratory and physical examinations. The results obtained in this clinical study were as follows (Table 1): Testicular sizes were decreased in Groups IV. Sertoli cell only syndrome, V. klinefelter`s syndrome, and VI. Eunuchoidism. Plasma LH levels were increased in Groups IV. Sertoli cell only syndrome, and V Klinefelter`s syndrome. Plasma FHS levels were increased in Groups IV. Sertoli cell only syndrome, and V. Klinefelter`s syndrome. The long-term hormonal therapy with high doses of human chorionic gonadotropin and human menopausal gonadotropin combined with testosterone was applied to a total of 216 infertile patients with small tests (less than 10ml in volume) for 12 months (range: 3-24 months). Semen parameters were improved in 10 patients who were severe oligozoospermia before the treatment and spermatogenesis was induced in 14 patients who were azoospermic before the treatment following the hormonal therapy. In conclusion, an infertile male with small testis (less than 10ml, should be adequately evaluated before declaration of final diagnosis of sterility.
Azoospermia ; Biopsy ; Chorionic Gonadotropin ; Diagnosis ; Eunuchism ; Germ Cells ; Gonadotropins ; Humans ; Infertility ; Infertility, Male ; Karyotype ; Male* ; Oligospermia ; Physical Examination ; Plasma* ; Semen ; Semen Analysis ; Sertoli Cell-Only Syndrome ; Spermatogenesis ; Spermatozoa ; Testis ; Testosterone

A retrospective study was performed on 2,774 infertile couples treated in National Institute of protection of Mother and Newborn from January 1995 to December 1995. 897 male subjects were selected according to semen analysis. The subjects were classified, and divided into primary and secondary infertility groups. Semen analysis shows: 496 cases (53.30%) with normal semen parameters. 204 cases (22.7%) were azoospermia. 233 cases (25.9%) were oligospermia (20 millions/ml sperm). 268 cases (30%) had  20% of strong spermatozoytes. 231 cases (25.7%) were oligospermia with  20% of strong spermatozoytes. All the male infertile patients have required the IAD practice for their partners, therefore a 'Bank of Spermatozoytes' must be recommended
Infertility ; Oligospermia ; Infertility, Male ; Therapeutics