Impaired spermatogenesis in men with congenital absence of the vas deferens

It is generally assumed that men with congenital bilateral absence of the v as deferens (CBAVD) have azoospermia because of obstruction and that sperm production is normal. This study examines spermatogenesis in men with CBAVD to assess the validity of this assumption. We identified all men with CBAV D who had undergone either a diagnostic or therapeutic fertility procedure. Procedures included diagnostic biopsy, testis fine needle aspiration (FNA) mapping, microscopic epididymal sperm aspiration (MESA), and testis sperm extraction (TESE). Among 33 CBAVD men, 18 underwent testis biopsy, 27 had M ESA/TESE, and 10 had FNA mapping, On evaluation of these procedures, normal spermatogenesis was present in 29 men. Four men (12%) demonstrated impaire d spermatogenesis. One patient had FNA testis cytology consistent with late maturation arrest, another demonstrated hypospermatogenesis on biopsy and low sperm yield by MESA, and two patients had pure Sertoli cell only histol ogy on biopsy. Aetiologies for impaired spermatogenesis included varicocele and underlying genetic abnormalities. Although patients with CBAVD are ass umed to have normal spermatogenesis and infertility due simply to obstructi on, the potential for concomitant defects in sperm production exists. A cli nical suspicion of testis failure should prompt further diagnostic evaluati on of spermatogenesis prior to sperm retrieval. In addition, genetic counse lling should be offered and testing for genetic lesions, including cystic f ibrosis gene mutations and/or variants, Y chromosome microdeletions, and ka ryotype abnormalities, should be considered.