Identification of seminiferous tubule aberrations and a low incidence of testicular microliths associated with the development of azoospermia

Objective: To evaluate the use of percutaneous testicular sperm aspiration in the assessment of azoospermia and its association with seminiferous tubu le microliths. Design: Case report. Setting: Tertiary care fertility center in a university hospital. Patient(s): Male undergoing infertility evaluation. Intervention(s): Testicular biopsy and percutaneous testicular aspiration. Main Outcome Measure(s): Serum hormone analysis, sperm concentration in sem en, spermatogenesis in samples from testicular biopsies and aspirations, an d microlith composition. Result(s): A patient presented for infertility evaluation with a history of severe oligospermia that progressed to azoospermia. The serum testosterone concentration (357 ng/dL) and LH concentration (9.2 mIU/mL) were normal an d the serum FSH concentration (18.3 mIU/mL) was elevated. Testicular biopsy results indicated spermatogenic hypoplasia with limited spermatozoa. Semin iferous tubules obtained by percutaneous testicular aspiration were structu rally aberrant, with multiple diverticula. Microliths averaging 120 mu m in diameter were observed within and blocking the seminiferous tubules. The m icroliths were composed of calcium phosphate (hydroxyapatite) in both the c ore and peripheral regions. Electron microscopy revealed a high degree of c ollagen-like material within the peripheral zone. Conclusion(s): The presence of seminiferous tubule microliths is associated with the development of azoospermia. In patients with a low incidence of s eminiferous tubule microliths and aberrant seminiferous tubule architecture , percutaneous testicular aspiration may provide a diagnostic advantage ove r testicular biopsy. (Fertil Steril(R) 1999;72:467-71. (C) 1999 by American Society for Reproductive Medicine.)