CORRELATION OF TESTICULAR PATHOLOGY AND SPERM EXTRACTION IN AZOOSPERMIC MEN WITH EJACULATED SPERMATIDS DETECTED BY IMMUNOFLUORESCENT LOCALIZATION

Limiting testicular biopsy for intracytoplasmic sperm injection (ICSI) to those with a high chance of having testicular spermatozoa has not been possible because of the poor predictive value of current clinical and laboratory methods. In order to predict testicular pathology and sperm extraction, we characterised the semen of 28 men with azoospermi a due to gonadal failure in terms of the presence of spermatids using an immunological method. The results were compared with the assessment of testicular biopsies by histology and the extraction of spermatozoa into culture medium. Washed cellular elements in the ejaculate were s meared on microscope slides and fixed in 100% methanol, before incubat ion with acrosome-specific monoclonal antibody (18.6), fluorescein iso thiocyanate-labelled anti-mouse goat Igc, and examination by epifluore scent microscopy, Semen from men with oligozoospermia and obstructive azoospermia served as positive and negative controls, respectively. Tw elve patients who had positive immunofluorescence (one or more spermat ids present) had spermatozoa retrieved from their testes (five hypospe rmatogenesis, seven focal spermatogenesis), and 16 patients with negat ive immunofluorescence (spermatids absent) had apparent Sertoli cell-o nly syndrome (12) or maturation arrest histological pattern (four), Ho wever, four patients with apparent Sertoli cell-only syndrome had test icular spermatozoa present after extraction from the biopsy. Plasma fo llicle stimulating hormone concentration and testicular volume did not predict retrieval of seminal spermatids or testicular spermatozoa. We conclude that the immunofluorescent localization of one or more sperm atids in the ejaculate can be used to predict the likelihood of obtain ing testicular spermatozoa for ICSI, However, in some patients with Se rtoli cell-only syndrome, spermatozoa could still be recovered in the absence of apparent seminal spermatids.