Human Reproduction, Vol 13, 3061-3065, Copyright © 1998 by Oxford University Press
UI Ezeh, M Martin, ID Cooke and HD Moore
Limiting testicular biopsy for intracytoplasmic sperm injection (ICSI) to
those with a high chance of having testicular spermatozoa has not been
possible because of the poor predictive value of current clinical and
laboratory methods. In order to predict testicular pathology and sperm
extraction, we characterised the semen of 28 men with azoospermia due to
gonadal failure in terms of the presence of spermatids using an
immunological method. The results were compared with the assessment of
testicular biopsies by histology and the extraction of spermatozoa into
culture medium. Washed cellular elements in the ejaculate were smeared on
microscope slides and fixed in 100% methanol, before incubation with
acrosome-specific monoclonal antibody (18.6), fluorescein
isothiocyanate-labelled anti-mouse goat IgG, and examination by
epifluorescent microscopy. Semen from men with oligozoospermia and
obstructive azoospermia served as positive and negative controls,
respectively. Twelve patients who had positive immunofluorescence (one or
more spermatids present) had spermatozoa retrieved from their testes (five
hypospermatogenesis, seven focal spermatogenesis), and 16 patients with
negative immunofluorescence (spermatids absent) had apparent Sertoli
cell-only syndrome (12) or maturation arrest histological pattern (four).
However, four patients with apparent Sertoli cell-only syndrome had
testicular spermatozoa present after extraction from the biopsy. Plasma
follicle stimulating hormone concentration and testicular volume did not
predict retrieval of seminal spermatids or testicular spermatozoa. We
conclude that the immunofluorescent localization of one or more spermatids
in the ejaculate can be used to predict the likelihood of obtaining
testicular spermatozoa for ICSI. However, in some patients with Sertoli
cell-only syndrome, spermatozoa could still be recovered in the absence of
apparent seminal spermatids.
ARTICLES
Correlation of testicular pathology and sperm extraction in azoospermic men with ejaculated spermatids detected by immunofluorescent localization
University Department of Obstetrics and Gynaecology, Jessop Hospital For Women, Sheffield, UK.
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