Disturbed spermatogenesis

Abstract In general, male fertility can be assessed using semen analysis, sex hormone levels and markers of accessory glands. Additional information can be obtained by examining testicular size, and especially by ultrasonographic examination of the testes. Follicle-stimulating hormone (FSH) is the classical endocrine parameter used to discriminate between testicular impairment and obstructions of the efferent ducts; however, a complete Sertoli-cell-only syndrome (SCO syndrome) can be found even in biopsies of patients with normal FSH serum levels and normal testicular volume (1). Moreover, since testicular exploration with sperm extraction (TESE) has become a means of treating patients with azoospermia, the importance of testicular biopsies has increased. To date, it is impossible to predict with accuracy the probatility of recovering mature spermatids via TESE, or to reliably distinguish obstructive azoospermia from nonobstructive azoospermia, even with the most advanced endocrine and genetic tests. At present, testicular biopsy is a therapeutic and diagnostic procedure, in combination with testicular sperm extraction and cryopreservation of testicular sperm (Chapter 9.3.6). Indications for testicular biopsy are azoospermia, necrozoospermia or severe oligozoospermia, and suspicous intratesticular lesions noted during ultrasonographic examination (2). Techniques for appropriate histological analysis are presented in Chapter 9.3.6.