Testicular sperm extraction in azoospermic men submitted to bilateral orchidopexy.
BACKGROUND
This study was carried out to evaluate whether bilateral orchidopexy represents a poor or good prognostic factor in azoospermic men undergoing testicular sperm extraction (TESE).


METHODS
One hundred and seven presumed non-obstructive azoospermia (NOA) patients, according to conventional clinical parameters (volume of testis, FSH, clinical history) were submitted to testicular biopsy with TESE. Thirty men (28%) had a history of bilateral orchidopexy for cryptorchidism.


RESULTS
Normal spermatogenesis or mild hypospermatogenesis was diagnosed in 12/30 ex-cryptorchid patients and in 7/77 presumed NOA patients (P = 0.0004). Conversely, pure Sertoli cell-only syndrome or complete maturation arrest was found in 10/30 ex-cryptorchid patients and in 48/77 presumed NOA patients (P = 0.0094). In 53/107 patients (49.5%), TESE allowed a positive sperm retrieval. At least one spermatozoon was observed in 22/30 ( approximately 73%) ex-cryptorchid patients and in 31/77 ( approximately 40%) presumed NOA patients (P = 0.0026). A large number of spermatozoa (equivalent to an obstructive pathology) were retrieved in 13/30 ex-cryptorchid and in 10/77 presumed NOA patients (P = 0.001). A history of bilateral orchidopexy in presumed NOA patients correlates positively for the chance of retrieving testicular spermatozoa (odds ratio 3.8; 95% confidence interval 1.41-10.21; P = 0.008).


CONCLUSIONS
Although bilateral cryptorchidism is usually considered a testicular secretive dysfunction, TESE permits retrieval of a large number of spermatozoa in almost 40% of cases. Our data suggest the existence of congenital or acquired obstructive anomalies of the seminal ducts in azoospermic orchidopexed men.
Negri
L
L
Departments of Reproductive Medicine and Anatomic Pathology, Istituto Clinico Humanitas, Via Manzoni 56, I-20089 Rozzano, Milan, Italy. luciano.negri@humanitas.it
Albani
E
E
DiRocco
M
M
Morreale
G
G
Novara
P
P
Levi-Setti
P E
PE
D000328:Adult; D002869:Chromosome Aberrations; D041322:Chromosomes, Human, Y / Q000235:genetics; D003456:Cryptorchidism / Q000601:surgery*; D019005:Cystic Fibrosis Transmembrane Conductance Regulator / Q000235:genetics; D005640:Follicle Stimulating Hormone / Q000032:analysis; D017353:Gene Deletion; D006801:Humans; D007713:Klinefelter Syndrome; D008297:Male; D009845:Oligospermia / Q000235:genetics / Q000628:therapy*; D013091:Spermatogenesis; D013094:Spermatozoa; D013737:Testis / Q000473:pathology* / Q000601:surgery*; D020858:Tissue and Organ Harvesting; D014178:Translocation, Genetic
C505032:CFTR protein, human; D019005:Cystic Fibrosis Transmembrane Conductance Regulator; D005640:Follicle Stimulating Hormone