PURPOSE: Because testicular biopsy traditionally has been performed as a separate operation, there are some needs for immediate interpretation of the testicular biopsy specimen in obstructive azoospermia patients. The realization that a proportion of patients with nonobstructive azoospermia harbor spermatozoa in their testicular parenchyma, combined with the ability of intracytoplasmic sperm injection(ICSI) to effect pregnancy with single sperm, has prompted clinicians to explore testicular sperm extraction(TESE) in these patients. We performed this study to investigate the meaning of touch imprint and TESE. MATERIALS AND METHODS: Fifty-two patients with azoospermia underwent touch imprint, TESE and simultaneous formal testicular biopsy. Testicular biopsy tissue was touched on a slide and stained using a Diff-Quik method. Tissue obtained from TESE was analyzed by intensive searching to find spermatozoa. RESULTS: Twenty-nine patients were determined as obstructive azoospermia including two cases of hypospermatogenesis, all patients had sperm seen on touch imprint and TESE. The other patients were diagnosed as nonobstructive azoospermia, testicular histology was divided into two main patterns: Sertoli cell only syndrome, spermatocytic arrest. Touch imprint failed to show sperm, but three of twenty patients(15%) with Sertoli cell only syndrome had sperm present during TESE. CONCLUSIONS: Touch imprint provides high quality cellular detail for immediate review, which can minimize the intraoperative time required to decide upon the appropriateness of correcting the ductal obstruction in obstructive azoospermia patients. Men with nonobstructive azoospermia may have mature spermatozoa present within their testicular parenchyma. Therefore intensive searching for presence of spermatozoa should be performed in tissue obtained from TESE by trained specialist.
Azoospermia* ; Biopsy* ; Humans ; Male ; Oligospermia ; Pregnancy ; Sertoli Cell-Only Syndrome ; Specialization ; Spermatozoa* ; Testis*

PURPOSE: We determined the usefulness of in vitro germ cell culture in nonobstructive azoospermic patients diagnosed with Sertoli cell only syndrome, no sperm in testicular sperm extraction. MATERIALS AND METHODS: This study included 44 patients (45 testicular tissues) with nonobstructive azoospermia who were diagnosed with Sertoli cell only syndrome and were found to have no sperm in testicular sperm extraction between January 2006 and July 2008. Among the 45 testicular tissues, 22 tissues were processed for culture. In the in vitro cultures, the testicular tissues were dissociated and plated on gelatin-coated dishes. Patients were divided into 2 groups according to culture success: group I, culture positive (+; n=10); and group II, culture negative (-; n=12). RESULTS: The mean patient ages were 31.73 and 31.68 years for groups I and II, respectively. The mean testicular sizes were 10.19 and 10.42 cc, respectively; the semen volumes were 2.86 and 3.04 cc, respectively; and the mean FSH, LH, and testosterone levels were 18.86 mIU/ml, 5.99 mIU/ml, and 4.46 ng/ml vs. 21.02 mIU/ml, 6.29 mIU/ml, and 4.32 ng/ml for groups I and II, respectively, with no significant differences between the groups (p>0.05). The culture rate of nonobstructive azoospermic patients diagnosed with Sertoli cell only syndrome was 45.5% (10/22). Round spermatid injection was done in 2 patients with consent of the patients, but implantation failed. Among the 45 tissues, germ cells were found in 8 tissues after pathologic reexamination. CONCLUSIONS: The in vitro culture of germ cells would be useful in the advanced treatment of nonobstructive azoospermic patients.
Azoospermia ; Germ Cells ; Humans ; Semen ; Sertoli Cell-Only Syndrome ; Spermatids ; Spermatozoa ; Testosterone

There were 122 infertile males who received testicular biopsy in our department during the period from 1978 to 1980. Among them, 20 patients were diagnosed to have Sertoli cell only syndrome by pathologic finding. A cumulative clinical investigation was undertaken in 20 patients with Sertoli cell only syndrome using history taking, orchidometer, semen analysis, and plasma hormonal assay (FSH. LH, & Testosterone). We found the interesting relationship between the size of the testis and plasma hormonal levels. 1. In pathologic finding, Sertoli cell only syndrome was 16%, spermatic arrest 16%, hypospermatogenesis 15%, peritubular fibrosis 15%, and normal testis accompanying obstruction of efferent duct 22%. 2. The size of the testis was average 12ml, and plasma FSH was increased to average 27.43 IU/L, plasma LH was also increased to average 25.9 IU/L, but plasma testosterone was within normal ranges (average 5.58 ng/ml).
Biopsy ; Fibrosis ; Humans ; Male ; Oligospermia ; Plasma* ; Reference Values ; Semen Analysis ; Sertoli Cell-Only Syndrome* ; Testis* ; Testosterone

This study was carried to determine the possibility of finding motile spermatozoa and fertilization, pregnancy rate after testicular sperm extraction(TESE) with ICSI in obstructive and non-obstructive azoospermic patients. In 154 cases(132 patients), obstructive azoospermia was 77 cases and non-obstructive azoospermia was 77 cases. In obstructive azoospermia, patients generally showed normal spermatogenesis and included vas agenesis(n=8), multiple vas obstruction(n=7), epididymal obstruction (n=54). Total of 982 retrieved oocytes were obtained and 84.4% were injected. The fertilization rates with 2 PN and cleavage rate were 72.5% and 62.3%, .respectively. 30 pregnancies(38.9%) were achieved and the ongoing pregnancies were 22 cases (28.6%). In non-obstructive azoospermia, patients showed hypospermatogenesis(n=49), maturation arrest(n=4), Sertoli cell only syndrome (n=24). The various stages of spermatogenic cell could be retrieved by TESE and could be reached normal fertilization and embryo development with ICSI. Total of 1072 retrieved oocytes obtained and 80.2% were injected. The fertilization rates with 2 PN and cleavage rate were 52.8% and 68.9%, respectively. 22 pregnancies(30.1%) were achieved and the ongoing pregnancies were 19 cases(26.0%). Conclusively, the combination of TESE with ICSI using testicular spermatozoa can achieve normal fertilization and pregnancy rate and effective method in obstructive and non-obstructive azoospermic patients.
Azoospermia ; Embryonic Development ; Female ; Fertilization* ; Humans ; Oocytes ; Pregnancy Rate* ; Pregnancy* ; Sertoli Cell-Only Syndrome ; Sperm Injections, Intracytoplasmic ; Spermatogenesis ; Spermatozoa*

Irreparable obstructive azoospermic patients can be treated successfully with microsurgical epididymal sperm aspiration(MESA) o. testicular sperm extraction (TESE) by intracytoplasmic sperm injection(ICSI). Obstructive azoospermic patients generally have normal spermatogenesis. The aim of this study was to see if any spermatozoa could be retrieved from non-obstructive azoospermia and to assess the efficacy of ICSI with TESE in germinal failure. 42 non-obstructive azoospermic patients revealed no spermatozoa at all in their ejaculates, even after centrifuge. The histology of 42 patients revealed 15 Sertoli cell only Syndrome, 4 maturation arrest and 23 severe hypospermatogenesis. All patients underwent extensive multiple testicular biopsy for sperm retrieval. These patients were scheduled for ICSI using testicular spermatozoa. In 25 out of 42 non-obstructive azoospermic patients, spermatozoa were recovered from multiple testicular biopsy specimen and 11 ongoing pregnancies were achieved. There are usually some tiny foci of spermatogenesis which allow TESE with ICSI in non-obstructive azoospermia. Also these patients may have sufficient sperm in the testes for ICSI, despite extremely high FSH level and small testes.
Azoospermia* ; Biopsy ; Humans ; Male ; Oligospermia ; Pregnancy ; Sertoli Cell-Only Syndrome ; Sperm Injections, Intracytoplasmic ; Sperm Retrieval ; Spermatogenesis ; Spermatozoa ; Testis

Investigations into the pathogenesis of male infertility have relied predominantly on two types of analysis: histological evaluations of testicular biopsies and assays of these hormones thought to be responsible for the regulation of spermatogenesis. Other types of analysis such as chromosomal studies and biochemical determinations of ejaculate components have also played a role in characterizing male infertility. Testis biopsy findings of 54 cases with azoospermia were observed in aspect of testicular size and pastory and seminovesiculograms were performed in 3 cases with normal testis and 1 case with peritubular fibrosis and reduced spermatogenesis. The following results were obtained. 1) Among the 42 cases with normal sized testis, 12 cases (28.6%) of normal testis, 10 cases (23.8%) of peritubular fibrosis with reduced spermatogenesis, 11 cases (26. 2%) of reduced spermatogenesis, 1 case(2.4%) of maturation arrest at spermatid level, 6 cases (14.3%) of Sertoli cell only syndrome and 2cases (4.7%) of hyalinized tubule with Leydig cell hyperplasia were observed. 2) Among the 12 cases with small sized testis, 1 case (8.3%) of normal testis, 1 case (8.3%) of peritubular fibrosis with reduced spermatogenesis, 2 cases(16.7%) of reduced spermatogenesis, 5 cases(41.7%) of Sertoli cell only syndrome and 3 cases (25.O%) of hyalinized tubule with Leydig cell hyperplasia were observed. 3) Normal testis was observed in 4 of 9 cases with tuberculous epididymitis and 1 case with surgically corrected bilateral hydrocele on their past history. Peritubular fibrosis with reduced spermatogenesis was observed in 3 of 9 cases with urethritis, 2of3 cases with tuberculous epididymitis and 1 case with surgically corracted bilateral varicocele on their past history. 4) The observed in 3 cases of normal testis and 1 carmel testis and 1 case of peritubular fibrosis with reduced spermatogenesis on the seminovesiculogram.
Azoospermia* ; Biopsy* ; Epididymitis ; Fibrosis ; Humans ; Hyalin ; Hyperplasia ; Infertility ; Infertility, Male ; Male ; Sertoli Cell-Only Syndrome ; Spermatids ; Spermatogenesis ; Testis* ; Urethritis ; Varicocele

ObjectiveTo investigate the 5'-flanking regulatory sequence methylation status of the Boule gene in the testis tissue of infertile men with Sertoli cell-only syndrome (SCOS).

METHODSWe collected biopsy samples of the testis tissue from 12 men with obstructive azoospermia (the control group) and 15 cases of SCOS, all without varicocele, cryptorchidism, or infectious disease. We extracted genomic DNA from the testis tissue of the SCOS patients, analyzed the characteristics of the 5'-flanking regulatory sequence of the Boule gene using the bioinformatics method, and detected the methylation status of the Boule gene by sodium bisulfite sequencing.

RESULTSA CpG island was observed in the 5'-flanking regulation region of the Boule gene. The methylation level of the Boule gene was remarkably higher in the SCOS group than in the obstructive azoospermia controls (61.4% vs 21.7%, P<0.01), with significant differences in the methylation levels of 14 CpG sites, namely, －58 bp, －50 bp, －48 bp, －38 bp, －28 bp, －24 bp, －20 bp, －15 bp, －1 bp, +5 bp, +8 bp, +15 bp, +29 bp, and +58 bp.

CONCLUSIONSThe methylation level of the Boule gene is significantly higher in the SCOS patients than in the obstructive azoospermia males, which suggests that the changes in Boule methylation may be associated with spermatogenic dysfunction.

Case-Control Studies ; DNA Methylation ; Humans ; Male ; RNA-Binding Proteins ; genetics ; Sertoli Cell-Only Syndrome ; genetics ; Spermatogenesis ; Testis ; metabolism

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*

The changes in the germinal epithelium of 27 azoospermic patients were studied by light and electron microscope. And a brief clinical observation was also made. The results obtained were as follows, 1) The two thirds of 27 cases were in the age group of 26 to 35. Fifteen cases (55.6%) were in the 2nd to 5th year of their marriages. The tendency of decreasing in tuberculous disease, gonorrhea and mumps was observed in their past history. The average volume of seminal fluid was 2.4ml in amount 2) Light microscopically, spermatogenic arrest was found in 22 cases, and followed by germinal tell aplasia in 3 and hypospermatogenesis in 2. Fifteen of 22 cases of spermatogenic arrest were relatively advanced. Two of 3 cases of germinal cell aplaeia were found in the older age group of 35 to 40, and both of two cases of hypospermatogenesis in the younger age group of 21 to 25. 3) On electron microscopic observation in the hypospermatogenesis, increase in number and mild vacuolar dilatation of endoplasmic reticulum and increase in number of lysosomes in the spermatocytes, and deformities and swelling of acrosomes and vacuolization of nucleoplasm in the spermatocytes, but no significant changes were seen in the spermatogonia and the Sertoli cells. 4) In the spermatogenic arrest, severe degenerative changes such as condensation of chromatin, occurrence of electron dense round bodies, and inapparent cell organells were observed in the spermatocytes. Mild to moderate degenerative changes such as increase in number and dilatation of endoplasmic reticulum, deformities, swelling or atrophy. and decrease in number of cristae of mitochondria were seen in the spermstogonia and the Sertoli cells 5) In the germinal cell aplasia, progressive and degenerative changes such as marked increase in number. vacuolar dilatation, and irregular arrangement of endoplasmic reticulum. marked deformities. swelling, vacuolization, and loss of cristae of mitochondria, and increase in number of lysosomes were noticed.
Acrosome ; Atrophy ; Chromatin ; Congenital Abnormalities ; Dilatation ; Endoplasmic Reticulum ; Epithelium* ; Gonorrhea ; Humans ; Infertility, Male ; Lysosomes ; Male ; Marriage ; Mitochondria ; Mumps ; Oligospermia ; Sertoli Cell-Only Syndrome ; Sertoli Cells ; Spermatocytes ; Spermatogonia

A total of 178 patients with Sertoli cell only syndrome proved by histologic examination was investigated for the past 7 years at the infertility Clinic of Seoul National University Hospital. The size of testes ranged from 5 to 25ml with the mean of 13ml(An average normal size of Korean males: l9ml) However, testes size of greater than l5ml were found in 53.3% of the patients. Plasma FSH Levels ranged from 0.31 to 58.501U/L with a mean of 20.451U/L(Normal level of Korean males: l2.10IU/L). Plasma LH levels ranged from 1.56 to 59.75IU/L with a mean of l2.87 IU/L( Normal level of Korean males: 9.21U/L). Plasma testosterone levels ranged from 0.9 to 11.0ng/ml with a mean of 5.5ng/ml Accordingly, increased FSH levels were found in 49.4% and increased LH levels, in 25.4% of the patients. And decreased levels of testosterone levels were found in 8.9% of the patients. Stimulation tests of LH and FSH by an administration of 100ug bolus of LHRH were attempted on 3 patients. The basal FSH values were elevated over 24.l8IU/L in the 3 patients. The FSH values were increased l.8-fold 90 minutes after stimulation tests. The basal value of LH was elevated in a patient. The LH values were increased 9.l-fold 30 minutes following the stimulation tests. Leydig cell hyperplasia and peritubular fibrosis were found in 2 patients who had shown the exaggerated responses to LHRH stimulation tests. The patients with more abundant microfilament in cytoplasm and increased intercellular digitation of Sertoli cells proved by an electron microscopic examination, had the higher levels of basal FSH and LH. Therefore, the regulatory mechanism of secretion of both FSH and LH appears to be abnormal in the patients with Sertoli cell only syndrome. The karyotype evaluation revealed 46XY in 20 patients, 46XY 15S- in l patient and 46XYt(7, 14) in 1 patient of the 22 patients. Sertoli cell only syndrome seems to be heterogenous or a single process which may be in evolution at different developmental stages. Germ cell aplasia was found in 21 patients with cryptorchidism by histological examination. We could infer the more abnormal regulation of secretion of both gonadotropins (FSH and LH) in patients of cryptorchidism with germ cell aplasia than patients of Sertoli cell only syndrome without cryptorchidism.
Actin Cytoskeleton ; Cryptorchidism ; Cytoplasm ; Fibrosis ; Germ Cells ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Hyperplasia ; Infertility ; Karyotype ; Male ; Plasma ; Seoul ; Sertoli Cell-Only Syndrome* ; Sertoli Cells ; Testis ; Testosterone