ARE SPERMATID INJECTIONS OF ANY CLINICAL-VALUE - ROSNI AND ROSI REVISITED

Tiny numbers of spermatozoa can be extracted from an extensive testis biopsy and be used successfully for intracytoplasmic sperm injection ( ICSI) in similar to 60% of cases of nonobstructive azoospermia caused by testicular failure (e.g. maturation arrest, Sertoli cell only, cryp torchid atrophy, post-chemotherapy, or even Klinefelter's syndrome). H owever, no sperm are recoverable in 40% of cases even after a very ext ensive testicular sperm extraction (TESE)-ICSI attempt. Round spermati d nucleus injection (ROSNI) and round spermatid injection (ROSI) would be an appropriate alternative if no elongated spermatozoa, or elongat ed spermatids were recoverable. Round cells are abundant in morselated testicular tissue of almost all azoospermic men, but difficulties ari se in distinguishing under Hoffman or Nomarski optics whether they are haploid round spermatids, diploid spermatocytes or spermatogonia, or even somatic cells like Sertoli cell nuclei or Leydig cells. This pape r attempts to clarify such confusion by reviewing data on 143 consecut ive testis biopsies of men with non-obstructive azoospermia due to ger minal failure, and 62 controls with obstructive azoospermia and normal spermatogenesis. In no cases were round spermatids found in the absen ce of elongated spermatozoa, and maturation arrest was found always to be a failure of progression beyond meiosis (not at maturation from ro und spermatid to mature elongated spermatid). Errors arising after inj ecting somatic or other round cells could result in an appearance rese mbling fertilization and cleavage, and explain reports of finding 'rou nd spermatids' in azoospermic men where no 'spermatozoa' were retrieva ble. The use of TESE-ICSI to achieve pregnancies in azoospermic men wi th deficient spermatogenesis is more concerned with finding tiny foci of spermatozoa, rather than searching for 'round spermatids', which ar e recoverable only if elongated forms are also available.