Human Reproduction, Vol 13, 3066-3074, Copyright © 1998 by Oxford University Press
UI Ezeh, HD Moore and ID Cooke
To identify the predictive factors for testicular sperm extraction (TESE)
and to understand the pathology associated with TESE, we carried out a
prospective study in 40 consecutive men with azoospermia due to primary
gonadal failure. The main outcome measure was the retrieval of at least one
testicular spermatozoon. Endocrine and biophysical profiles, testicular
histology, Johnsen score and testicular spermatids were used as predictors
of sperm extraction. Spermatogenesis was quantified with the Johnsen score.
A variable pattern of spermatogenesis was common, being present in 20 (50%)
patients. Visualisation of testicular spermatids on testicular histology
showed a strong association with TESE (P < 0.0001). Statistically
significant differences were detected in plasma follicle stimulating
hormone (FSH) and testicular volume between patients who had
hypospermatogenesis and Sertoli cell-only or maturation arrest. There were
no significant differences in Johnsen score, biophysical and endocrine
profiles between the groups with successful and failed TESE. However, a
statistically significant trend occurred with changes in histological
pattern [chi2 for trend, P = 0.001; Pearson's coefficient (r) = 0.6],
Johnsen score (P = 0.022; r = 0.5), testicular volume (P = 0.01; r = 0.5)
and plasma FSH concentrations (P = 0.044; r = 0.4), albeit to a limited
degree. Difference in the interpretation of histological patterns with
different assessors was observed. The type of occupation or risk factors
for azoospermia showed no association with testicular pathology or TESE.
Variable histological patterns in different tubules in the same individual
may explain the poor correlation of TESE with endocrine and biophysical
profiles, Johnsen score and histological pattern. Differences in the amount
of tissue used for TESE and histopathology, and misinterpretation of
testicular histology rather than failure to quantify spermatogenesis may
explain the poor correlation between histological patterns and TESE.
Testicular spermatids predicted TESE. However, considerable overlap in
values means that no single variable can provide a perfect discrimination
between the groups with successful and failed TESE.
ARTICLES
Correlation of testicular sperm extraction with morphological, biophysical and endocrine profiles in men with azoospermia due to primary gonadal failure
University Department of Obstetrics and Gynaecology, Jessop Hospital For Women, Sheffield, UK.
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