Human Reproduction, Vol 13, 3332-3337, Copyright © 1998 by Oxford University Press
SJ Silber, R Alagappan, LG Brown and DC Page
Y chromosome deletions encompassing the AZFc region have been reported in
13% of azoospermic men and 7% of severely oligozoospermic men. We examined
the impact of these Y deletions on the severity of testicular defects in 51
azoospermic men undergoing intracytoplasmic sperm injection (ICSI) after
testicular sperm extraction (TESE) and 30 men with severe oligozoospermia
undergoing ICSI after ejaculation of spermatozoa. In addition, five
azoospermic patients shown previously to have Y chromosome deletions
underwent histological evaluation of their previously obtained testis
biopsy specimens. A further 27 azoospermic men underwent TESE-ICSI, but not
Y chromosome DNA testing. Ten of 51 azoospermic men (20%) who underwent
TESE-ICSI and Y-DNA testing were found to be deleted for portions of the Y
chromosome AZFc region. Of these 10, five had spermatozoa retrievable from
the testis, and in two cases the wives became pregnant. Of the 41
azoospermic men with no Y chromosome deletion, 22 (54%) had spermatozoa
retrievable from the testis, and in 12 cases (29%) the wives became
pregnant. Four of 30 (13%) severely oligozoospermic patients were found to
be deleted for AZFc and in three (75%) of these pregnancy was achieved. The
other 26 severely oligozoospermic couples who had no AZFc deletions
underwent ICSI, and 12 (46%) have an ongoing or delivered pregnancy. The
embryo implantation rate was not significantly different for azoospermic
(22%), oligozoospermic (16%), Y-deleted (14%) or Y-intact (18%) men. Of the
total of 19 infertile men who had Y chromosome deletions, 14 had deletions
within Y chromosome intervals 6D-6F, in the AZFc region. Twelve of those 14
had some spermatozoa (however few in number) in the ejaculate or testis.
Five of the Y-deleted men had deletions that extended more proximally on
the Y chromosome, and in none of these could any spermatozoa be observed in
either ejaculate or testis. These results support the concept that, in
azoospermic or oligozoospermic men with Y chromosome deletions limited to
intervals 6D-6F (AZFc), there are generally very small numbers of
testicular or ejaculated spermatozoa. Larger Y deletions, including and
extending beyond the AZFc region and encompassing more Y genes, tend to be
associated with a total absence of testicular spermatozoa. In those cases
where spermatozoa were retrieved, the presence of Y deletions had no
obvious impact on fertilization or pregnancy rate.
ARTICLES
Y chromosome deletions in azoospermic and severely oligozoospermic men undergoing intracytoplasmic sperm injection after testicular sperm extraction
Infertility Center of St Louis, St Luke's Hospital, MO 63017, USA.
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