New concepts in operative andrology: a review

[Usefulness and necessity of the andrologist in assisted reproductions units]

In this issue we make a review of our experience in the management of the sterile men: protocols used for the study of men's sterility, causes and specific treatments, surgical recovery of spermatozoa and screening before IVF or IVF-ICSI. We concluded that with an adequate protocol, it's possible to establish the aetiology of men's infertility in a 78.8% of the cases and it's also possible to initiate a specific treatment in almost a 47.8% of men. Results of specific treatment, with a previous selection of patients, could be better than those of assisted reproduction techniques. Best results are obtained in cases of vaso-vasostomy (vasectomy reversal) and obstruction of ejaculatory duct. It's also needed a study of genetics causes and bad prognostic circumstances in those men whose partner is going on with an IVF or IVF-ICSI cycle.

Correlation between fluorescence in situ hybridization and testicular biopsy for the prediction of spermatogenesis in 37 patients with nonobstructive azoospermia

OBJECTIVES

We applied interphase fluorescence in situ hybridization (FISH) to testis sections to examine the evidence of spermatogenesis in patients with nonobstructive azoospermia. This technique was evaluated and compared with conventional testicular histopathologic findings for the possibility of additional clinical applications.

METHODS

Thirty-seven consecutive patients with nonobstructive azoospermia were carefully evaluated clinically. Testes were biopsied for both sperm extraction and histopathologic examination. FISH staining was performed with a CEP 18 SpectrumAqua/CEP X SpectrumGreen/CEP Y SpectrumOrange probe.

RESULTS

Eight of 11 cases (sensitivity 73%) that were found to have spermatids on the histopathologic slides also were proven to produce haploid cells by FISH staining. On the other hand, 21 of the 26 cases (specificity 81%) for which no spermatids could be found on the histopathologic slides also had only diploid cells by FISH staining. On the basis of the good correlation between the FISH staining and conventional histopathologic findings, we could confirm the diagnosis of spermatogenesis using both methods.

CONCLUSIONS

FISH staining of testicular sections allows more reliable prediction of spermatogenesis and provides benefits for a patient's decision regarding fertility counseling.

Lack of evidence of a genetic origin in the impaired spermatogenesis of a patient cohort with low-grade varicocele

Varicocele is the most common clinical finding in infertile men but controversy continues to surround the utility of its treatment. An increased response of FSH to gonadotrophin-releasing hormone testing has been described in patients with varicocele, while the co-influence of Yq chromosome microdeletions in the infertility associated to this pathology is still under investigation. We studied 30 patients with first- and second-grade varicocele, 15 idiopathic oligozoospermic men and 21 age-matched healthy controls. All subjects underwent testicular Doppler ultrasonography, semen analysis, gonadotrophin-releasing hormone testing and baseline blood sampling for total and free testosterone, PRL, 17beta-estradiol, SHBG evaluation and Yq chromosome analysis. Apart from FSH, no difference in baseline hormonal levels was found between the groups. The patients with varicocele showed both an increased basal (p=0.007) and GnRH-induced FSH response (peak and AUC) (p=0.004) in comparison with the controls, while the idiopathic oligozoospermic men had only higher GnRH-induced FSH AUC (p=0.04). In the varicocele group, FSH peaks after GnRH testing correlated positively with the grade of disease (r=0.42, p=0.02) and negatively with sperm count (r=-0.50, p=0.005) and bilateral testis volume (r=-0.52, p=0.005). Sperm count and sperm motility were similarly significantly reduced both in patients with varicocele and in patients with idiopathic oligozoospermia in comparison with healthy controls. Yq chromosome analysis by sequence-tagged site PCR revealed no microdeletion in the AZF regions in any subject studied. Given the quite small number of subjects studied, our overall findings can only prompt us to suggest a possible causal role of varicocele in the impairment of spermatogenesis in our patients. Furthermore, although a genetic co-influence (i.e. Yq microdeletions) does not seem to be involved in the pathogenesis of infertility in men with varicocele and mild to moderate oligozoospermia, genetic screening seems to be advisable, especially in those patients who present a severe impairment of sperm count, as has been suggested by recent literature data.