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Human Reproduction, Vol. 16, No. 2, 263-267, February 2001
© 2001 European Society of Human Reproduction and Embryology

Successful treatment with ICSI of infertility caused by azoospermia associated with adrenal rests in the testes: Case report

H. Murphy1, C. George1, D. de Kretser2 and S. Judd1,,3

1 Departments of Medicine and Reproductive Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia 5042 and 2 The Monash Institute of Reproduction and Development, Monash University Centre, Clayton, Victoria, Australia 3168

Congenital adrenal hyperplasia (CAH) is a well-recognized, but uncommon, cause of azoospermia and infertility in men. Commonly this is due to undertreatment of excessive adrenal androgen secretion which suppresses gonadotrophin stimulation of the testes. A less common complication of CAH is development of adrenal tissue within the testes; this is important to recognize because it may be confused with malignancy leading to unnecessary surgery. In this case report, a man is described with simple virilizing CAH due to 21-hydroxylase deficiency who presented with azoospermia and was found to have adrenal rests. Investigations concluded that there was adequate adrenal suppression with glucocorticoids and that azoospermia was due to obstruction by adrenal rest tissue, strategically situated at the hilum of the testes. Spermatozoa were able to be retrieved by testicular aspiration from the man and these were used to successfully establish a pregnancy using intracytoplasmic sperm injection of his wife's oocytes.

Key words: adrenal rests/azoospermia/congenital adrenal hyperplasia/intracytoplasmic sperm injection

3 To whom correspondence should be addressed at: Department of Medicine and Reproductive Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia 5042


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