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Human Reproduction, Vol. 18, No. 12, 2534-2539, December 2003
© 2003 European Society of Human Reproduction and Embryology

Testicular sperm extraction in azoospermic men submitted to bilateral orchidopexy

L. Negri1,3, E. Albani1, M. DiRocco2, G. Morreale1, P. Novara1 and P.E. Levi-Setti1

Departments of 1 Reproductive Medicine and 2 Anatomic Pathology, Istituto Clinico Humanitas, Via Manzoni 56, I-20089 Rozzano, Milan, Italy

3 To whom correspondence should be addressed. e-mail luciano.negri{at}humanitas.it

BACKGROUND: This study was carried out to evaluate whether bilateral orchidopexy represents a poor or good prognostic factor in azoospermic men undergoing testicular sperm extraction (TESE). METHODS: One hundred and seven presumed non-obstructive azoospermia (NOA) patients, according to conventional clinical parameters (volume of testis, FSH, clinical history) were submitted to testicular biopsy with TESE. Thirty men (28%) had a history of bilateral orchidopexy for cryptorchidism. RESULTS: Normal spermatogenesis or mild hypospermatogenesis was diagnosed in 12/30 ex-cryptorchid patients and in 7/77 presumed NOA patients (P = 0.0004). Conversely, pure Sertoli cell-only syndrome or complete maturation arrest was found in 10/30 ex-cryptorchid patients and in 48/77 presumed NOA patients (P = 0.0094). In 53/107 patients (49.5%), TESE allowed a positive sperm retrieval. At least one spermatozoon was observed in 22/30 (~73%) ex-cryptorchid patients and in 31/77 (~40%) presumed NOA patients (P = 0.0026). A large number of spermatozoa (equivalent to an obstructive pathology) were retrieved in 13/30 ex-cryptorchid and in 10/77 presumed NOA patients (P = 0.001). A history of bilateral orchidopexy in presumed NOA patients correlates positively for the chance of retrieving testicular spermatozoa (odds ratio 3.8; 95% confidence interval 1.41–10.21; P = 0.008). CONCLUSIONS: Although bilateral cryptorchidism is usually considered a testicular secretive dysfunction, TESE permits retrieval of a large number of spermatozoa in almost 40% of cases. Our data suggest the existence of congenital or acquired obstructive anomalies of the seminal ducts in azoospermic orchidopexed men.

Key words: azoospermia/cryptorchidism/male infertility/seminal duct obstruction/sperm extraction/testicular


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