Human Reproduction, Vol 13, 1230-1234, Copyright © 1998 by Oxford University Press
D Jezek, UA Knuth and W Schulze
Spermatozoa recovered from testicular biopsies can be used through
intracytoplasmic sperm injection (ICSI) to achieve a pregnancy. To assess
the likelihood of successful testicular sperm extraction (TESE) in men
suffering from severe oligo- or azoospermia, bilateral biopsy specimens
were obtained. Following semi-thin sectioning, the morphology of testicular
samples was graded according to a modified Johnsen score. TESE was
performed in parallel to this histological examination. The number of
isolated spermatozoa was assessed in a semiquantitative way. From 103
patients investigated, 64 (62.1%) showed azoospermia in a preceding semen
analysis and 29 (28.2%) patients had sperm concentrations between 0.1 and 1
x 10(6)/ml. In 10 patients who had higher sperm counts, most spermatozoa
were non-motile. Spermatozoa could be detected after TESE in the testicular
tissue of 49 (77%) azoospermic men. When follicle stimulating hormone (FSH)
concentration was normal, most patients had detectable spermatozoa after
TESE. Nearly one-third of patients with mildly elevated FSH had no
spermatozoa. Thirty-nine percent of patients in whom FSH was elevated to
more than twice normal and 50% of patients with grossly elevated FSH had no
detectable spermatozoa. In all, 82.8% of men with sperm concentrations
between 0.1 and 1x10(6)/ml in their ejaculate showed spermatozoa in the
tissue sample after TESE. Our data demonstrate that, contrary to previous
recommendations, infertile men with azoospermia and high FSH values should
be reconsidered for testicular biopsy, provided that tissue samples can be
cryopreserved for later TESE/ICSI treatment.
ARTICLES
Successful testicular sperm extraction (TESE) in spite of high serum follicle stimulating hormone and azoospermia: correlation between testicular morphology, TESE results, semen analysis and serum hormone values in 103 infertile men
Institute of Histology and Embryology, Zagreb Medical School, Croatia.
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