Subtotal obstruction of the male reproductive tract.
Bilateral obstruction of the male reproductive tract is suspected in men with azoospermia, normal testicular volume and normal FSH. A testicular biopsy is required to differentiate between an obstruction and a testicular insufficiency. Unilateral or subtotal bilateral obstructions and epididymal dysfunction may cause severe oligozoospermia in men with a normal spermatogenesis. However, information on spermatogenesis in oligozoospermic men is lacking, since testicular biopsy is not routinely performed. Men with a sperm concentration of <1 x 10(6) spermatozoa/ml were investigated for possible partial obstruction by performing a testicular biopsy under local anaesthesia. Spermatogenesis was determined by the Johnsen scoring method. A testicular biopsy was performed in 78 men with severe oligozoospermia. The medical history showed male accessory gland infection in 12.8%, previous hernia repair in 14.1% and a history of cryptorchidism in 12.8%. A normal or slightly disturbed spermatogenesis (Johnsen score >8) was present in 39/78 (50%) of the men. Hernia repair occurred more often in men with normal spermatogenesis. A varicocele was predominantly seen in men with a disturbed spermatogenesis. FSH was significantly lower ( P<0.0001) in men with normal spermatogenesis. Subtotal obstruction of the male reproductive tract is a frequent cause of severe oligozoospermia in men with a normal testicular volume and a normal FSH. In other cases, an epididymal dysfunction might explain the oligozoospermia in men with a normal testicular biopsy score.
Dohle
G R
GR
Department of Andrology, Erasmus University Medical Centre, Rotterdam, The Netherlands g.r.dohle@erasmusmc.nl
van Roijen
J H
JH
Pierik
F H
FH
Vreeburg
J T M
JT
Weber
R F A
RF
D001706:Biopsy; D004822:Epididymis / Q000473:pathology* / Q000601:surgery; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D008297:Male; D008866:Microsurgery; D009845:Oligospermia / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D013091:Spermatogenesis
D005640:Follicle Stimulating Hormone