Identification of spermatozoa and round spermatids in the ejaculates of men with spermatogenic failure.
OBJECTIVE
As many as 10% of infertile men have azoospermia caused by spermatogenic failure or ductal obstruction. The histologic diagnoses associated with spermatogenic failure--Sertoli cell-only syndrome, maturation arrest, and hypospermatogenesis--do not necessarily represent global changes in the affected testis, as occasional seminiferous tubules may still produce mature germ cells. Intracytoplasmic sperm injection (ICSI) allows individual sperm that have been isolated from testicular tissue to fertilize oocytes. This study assessed whether mature germ cells (either round spermatids or spermatozoa) were present in the ejaculates of patients with spermatogenic failure.


METHODS
All semen analyses performed at our tertiary care institution from January 1993 through December 1995 were reviewed to identify azoospermic men with spermatogenic failure. During this period, our laboratory employed Nuclear-Fast Red and picroindigocarmine staining (NF-PICS) of cytospin slides to identify rare spermatozoa and spermatids in otherwise azoospermic ejaculates.


RESULTS
Of 3005 analyses reviewed, 20 azoospermic men whose infertility was solely attributable to spermatogenic failure were identified. The histologic diagnoses were germinal cell aplasia (n = 7), complete maturation arrest (n = 6), incomplete maturation arrest (n = 3), and hypospermatogenesis (n = 4). Using the NF-PICS technique, mature germ cells were identified in the ejaculates of 15 men (75%), and 9 men (45%) had fully formed spermatozoa present.


CONCLUSIONS
In the clinical management of azoospermic infertile men, the NF-PICS technique may be used to identify men who have some degree of testicular spermatogenesis. This might obviate the need for the purely diagnostic testis biopsy that is performed before therapeutic biopsy for testicular sperm extraction in conjunction with ICSI.
Hendin
B N
BN
Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
Patel
B
B
Levin
H S
HS
Thomas
A J
AJ
Agarwal
A
A
D001706:Biopsy; D004396:Coloring Agents; D004542:Ejaculation; D004543:Ejaculatory Ducts; D005832:Genital Diseases, Male / Q000150:complications; D006801:Humans; D007202:Indicators and Reagents; D007203:Indigo Carmine; D007248:Infertility, Male / Q000209:etiology / Q000473:pathology; D008297:Male; D009499:Neutral Red; D009845:Oligospermia / Q000150:complications; D010851:Picrates; D012661:Semen / Q000737:chemistry / Q000166:cytology; D012671:Seminiferous Tubules / Q000473:pathology; D012708:Sertoli Cells / Q000473:pathology; D013079:Sperm Maturation; D013087:Spermatids / Q000145:classification* / Q000166:cytology / Q000254:growth & development; D013091:Spermatogenesis; D013094:Spermatozoa / Q000145:classification* / Q000166:cytology / Q000254:growth & development; D013737:Testis / Q000473:pathology
D004396:Coloring Agents; D007202:Indicators and Reagents; D010851:Picrates; D009499:Neutral Red; C005858:picric acid; D007203:Indigo Carmine