DIAGNOSTIC AND CLINICAL-FEATURES IN AZOOSPERMIA

BACKGROUND AND OBJECTIVE The recent advances in assisted fertilization and gamete micromanipulation techniques have enabled fertilization in some forms of azoospermia; for example, epididymal sperm aspiration i n obstructive azoospermia. Therefore knowledge of the specific degree of testicular damage is of primary importance, since other clinical pa rameters, such as FSH plasma levels and testicular volume, do not disc riminate between the different testiculopathies. In order to further c haracterize the specific testicular conditions present in azoospermia, we have examined a large group of azoospermic subjects on the basis o f testicular cytological analysis obtained by fine needle aspiration. DESIGN AND PATIENTS One hundred and twenty-two infertile, azoospermic men were studied by physical examination, FSH radioimmunoassay, testic ular ultrasound examination and fine needle aspiration of the testes. Thirty-five infertile normozoospermic subjects were studied as control s. RESULTS The cytological analysis identified five different sub-type s in azoospermic subjects: I, Sertoli cell-only syndrome; II, hyposper matogenesis; III, spermatogonial and/or spermatocytic arrest; IV, sper matidic arrest; and V, normal germ line. The testicular volume was red uced in groups I and II, while the FSH plasma levels were increased in groups I, II and III, suggesting a primary role of spermatids in the control of FSH secretion. CONCLUSIONS In azoospermic subjects, testicu lar cytological analysis permits the identification of different sub-t ypes and this classification may be very important in determining ther apy, particularly the choice between surgical treatment and the hypoth etical use of assisted fertilization techniques by retrieval of epidid ymal or intratesticular spermatozoa or spermatids.