Role of testicular tissue telomerase assay for the prediction of the presence of testicular spermatozoa in azoospermic men with varicoceles, pre- and post-varicocelectomy

Evaluating the Predictive Value of Diagnostic Testicular Biopsy for Sperm Retrieval Outcomes in Men with Non-Obstructive Azoospermia

BACKGROUND

Non-obstructive azoospermia (NOA) presents a challenge in male infertility management. This study aimed to assess the efficacy of diagnostic testicular biopsy (DTB) in predicting sperm retrieval success via therapeutic testicular biopsy (TTB) and to understand the role of systemic inflammation in microdissection testicular sperm extraction (mTESE) outcomes.

METHODS

A retrospective analysis was conducted on 50 NOA males who underwent mTESE at the University of Ioannina's Department of Urology from January 2017 to December 2019. All participants underwent thorough medical evaluations, including semen analyses and endocrinological assessments.

RESULTS

DTB did not detect spermatozoa in half of the patients who later showed positive sperm findings in TTB. Preoperative variables, such as age, plasma levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), prolactin (PRL), estradiol (E2), and inflammation biomarkers (neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-eosinophil ratio (MER)), were not consistently predictive of sperm retrieval success. Notably, TTB-negative patients had elevated NLR and PLR values, suggesting a possible link between systemic inflammation and reduced sperm retrieval during mTESE.

CONCLUSIONS

The findings question the necessity of an initial DTB, which might provide misleading results. A negative DTB should not deter further TTB or intracytoplasmic sperm injection (ICSI) attempts. The study emphasizes the need for further research to refine diagnostic approaches and deepen the understanding of factors influencing sperm retrieval in NOA patients, ultimately enhancing their prospects of biological parenthood.

Varicoceles in Men With Non-obstructive Azoospermia: The Dilemma to Operate or Not

The knowledge on male reproduction is constantly expanding, especially in treating infertility due to non-obstructive azoospermia (NOA). Varicocele is occasionally diagnosed in a subpopulation of males with NOA. Varicocele repair in NOA-men may contribute to the reappearance of spermatozoa in semen. However, spontaneous pregnancies are observed in only a small percentage of NOA-men post-varicocelectomy. Additionally, it has been reported that the repair of varicocele in NOA-men (before the performance of sperm retrieval techniques) may increase the testicular sperm recovery rate. In addition, it increases the pregnancy rate in intracytoplasmic sperm injection (ICSI) programs in NOA-men without spermatozoa in the semen post-varicocelectomy. In addition, to the improvement in Sertoli cellular secretory function, varicocelectomy may increase the secretory function of Leydig cells, which subsequently results in improved androgen production, raising the probability to negate the need for testosterone replacement therapy in cases of late-onset hypogonadism. On the other hand, the benefit of varicocelectomy in patients with NOA is still debatable. The current review study aims to provide a critical and extensive review of varicocele repair in males with NOA. This study additionally focuses on the impact of varicocele repair on sperm retrieval rates and its influence on the ICSI outcomes for those couples who remain negative for spermatozoa in their semen samples post-varicocelectomy.

Methylation status of the SNRPN and HUMARA genes in testicular biopsy samples

OBJECTIVE

To analyze the methylation status of two differentially inherited and methylated loci (the human androgen receptor [HUMARA] and the small nuclear ribonucleoprotein-associated polypeptide N [SNRPN] gene) in testicular biopsy samples, and to compare the results with microscopic evaluation.

DESIGN

Retrospective study.

SETTING

Infertility clinics and genetics laboratories.

PATIENT(S)

Twelve obstructive and 74 nonobstructive azoospermic men.

INTERVENTION(S)

Deoxyribonucleic acid samples from testicular biopsies and peripheral blood were modified with sodium bisulfite and amplified by methylation-specific polymerase chain reaction assay. Polymerase chain reaction primers specific for the methylated regions of the HUMARA locus and for the methylated and unmethylated CpG islands of the SNRPN gene were used.

MAIN OUTCOME MEASURE

Polymerase chain reaction product bands specific for methylated and unmethylated alleles.

RESULT(S)

Obstructive azoospermia patients were positive for spermatozoa and germ cells by all approaches (microscopic, HUMARA, and SNRPN analysis) with absolute consistency. In contrast, for the nonobstructive men, microscopy was consistent with SNRPN analysis as regards the presence of germ cells in 82% of the testicular tissues tested. Nonobstructive patients with maturation arrest were positive for the presence of germ cells only by HUMARA analysis, with 84% sensitivity.

CONCLUSION(S)

Methylation analysis of testicular tissue is consistent with microscopic analysis, in terms of the prevalence of germ cells and the stage of spermatogenic arrest in biopsy samples.

Apoptotic Sertoli cell death in hypogonadic (hgn/hgn) rat testes during early postnatal development

AIM

To determine the involvement of apoptotic cell death in postnatal pathogenesis in mutant strain of hypogonadic (hgn/hgn) rats testes. We evaluated the numbers and types of cells undergoing apoptotic cell death.

METHODS

Tissue sections were stained by the TUNEL method for in situ detection of apoptotic cells, with specific antibodies used as markers of testicular somatic and germ cells.

RESULTS

We found that apoptosis in the hgn/hgn testes during the early postnatal period occurred primarily in Sertoli cells, which should actively proliferate during this stage of differentiation. These findings strongly suggest that the normal allele of hgn is involved in the direct or indirect control of differentiation and proliferation of Sertoli cells.

CONCLUSION

To our knowledge, this is the first report demonstrating early postnatal apoptosis of Sertoli cells, suggesting that the hgn/hgn rat is a unique model for the study of Sertoli cell deficiency.