Azoospermia: is sample centrifugation indicated? A national survey of practice and the Oxford experience

Swanton, Alexander; Itani, Aysha; McVeigh, Enda; Child, Tim

doi:10.1016/j.fertnstert.2006.11.121

Cited by 17 publications

(10 citation statements)

References 18 publications

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“…It is widely known that severely oligozoospermic semen may be reported as azoospermia unless semen samples are examined carefully. Although routine microscopic semen examination might find no sperm in severe oligozoospermic patients, after centrifugation, several viable sperm can be found to use for IVF/ICSI procedure (Ron‐El et al, 1997; Swanton et al, 2007). Five patients (12.8%) in our study group became azoospermic and no sperm were found even after a thorough search following centrifugation of semen specimens.…”

Section: Discussionmentioning

confidence: 99%

Natural Course of Severe Oligozoospermia in Infertile Male: Influence on Future Fertility Potential

Song

Bak

Lim

et al. 2010

Journal of Andrology

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Most couples with severe male factor infertility are treated with assisted reproduction technology and little has been known about the prognosis of severe male factor infertility itself. We investigated the prognosis of infertile male patients with severe oligozoospermia. Thirty-nine patients with severe nonobstructive oligozoospermia were followed more than 6 months without any medical or surgical intervention. Retrospective analyses of the natural sequence of the condition and influences on the future fertility potential of the study participants were conducted. Sperm concentration, motility, and morphology between first semen analysis and last semen analysis were not significantly different. However, during the follow-up period, 5 (12.8%) patients became azoospermic. In 7 (17.9%) patients, the sperm count declined to a severe level that could be detected only after centrifugation. Three patients underwent microdissection testicular sperm extraction (TESE) for sperm retrieval after confirmation of azoospermia. The sperm retrieval was successful only in 1 of the 3 patients. Therefore, male patients diagnosed with severe oligozoospermia should be informed about possible aggravation of their residual spermatogenesis function and the necessity of intermittent follow-up semen analyses. If follow-up semen tests show a declining tendency, sperm cryopreservation may be recommended for these patients. If azoospermia develops during the follow-up period, early TESE procedure should be considered to improve the chance of sperm retrieval.

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Section: Discussionmentioning

confidence: 99%

Natural Course of Severe Oligozoospermia in Infertile Male: Influence on Future Fertility Potential

Song

Bak

Lim

et al. 2010

Journal of Andrology

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“…In conclusion, the present study established a stringent flow cytometric method which should improve accuracy for the detection of germ cells in the ejaculates of azoospermic, cryptozoospermic and serve oligozoospermic patients. Whereas incidence of HC cells in azoospermic ejaculates may suggest minimal spermatogenic activity which evades detection by routine semen analysis, 20,22 the presence of 1N and 4N cells in semen of any patients provides noninvasive information about their spermatogenic status. In view of the observation in TESE‐ICSI cases that elongated testicular spermatozoa can be found whenever round spermatids are present in the testicular histology 9 the occurrence of ejaculated 1N cells, especially in form of distribution peaks, may be informative for the indication of this assisted reproductive therapy.…”

Section: Discussionmentioning

confidence: 99%

The presence of germ cells in the semen of azoospermic, cryptozoospermic and severe oligozoospermic patients: stringent flow cytometric analysis and correlations with hormonal status

Yeung

Beiglböck‐Karau

Tüttelmann

et al. 2007

Clinical Endocrinology

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“…An azoospermia diagnosis was determined with two centrifuged semen samples collected after a 3-to 4-day abstinence period. 6 The Andros-Italia Institutional Review Board authorized the study, and the patients gave written informed consent for the 'off-label' administration of letrozole.…”

Section: Methodsmentioning

confidence: 99%

Preliminary study of letrozole use for improving spermatogenesis in non-obstructive azoospermia patients with normal serum FSH

Cavallini

Beretta²,

Biagiotti³

2011

Asian J Androl

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We investigated whether letrozole (2.5 mg day 21 ) improves sperm count in non-obstructive azoospermia (NOA) patients. Four men were included in this study, and they had folliculo-stimulating hormone and other hormone levels within the normal range and no varicoceles or chromosomal aberrations. These four patients were administered letrozole for 3 months. Sperm count, testicular volume, gonadotropin, testosterone (T) and estradiol (E2) blood levels were assessed before, during and 1 week after the suspension of treatment. All patients showed spermatozoa in their ejaculate, increased gonadotropin and T levels and lower E2 levels (P,0.05 in all cases), when letrozole was administered. This suggests that letrozole treatment might improve sperm count in an NOA sub-population; however, more studies, including the proper controls, are needed to confirm its efficacy. Asian Journal of Andrology (2011) 13, 895-897; doi:10.1038/aja.2011.44; published online 27 June 2011Keywords: letrozole; medical treatment; non-obstructive azoospermia; spermatogenesis INTRODUCTION Azoospermia indicates the absence of spermatozoa in the ejaculate after two assessments of centrifuged semen. Its prevalence is about 1% in the general population and 10%-15% in infertile couples. 1 Azoospermia is classified as obstructive (OA) or non-obstructive (NOA). NOA is defined by the clinical evidence of strongly affected spermatogenesis, and OA results from a seminal-tract obstruction. Men with OA typically have normal-sized testes, possible epididymal fullness and normal serum follicle-stimulating hormone (FSH) levels. Men with NOA present frequently with small testes and an elevated FSH level; however, a minority of these men have normal testicles and FSH levels within the normal range. 2 Only men with hypogonadotropic-hypogonadism NOA or varicocele-associated NOA may yield spermatozoa in their ejaculate after treatment; however, the majority of men with NOA and normal or elevated FSH levels are only able to father children after surgical retrieval of the spermatozoa from the testicles, which is performed by testicular sperm extraction (TESE) or with fine-needle aspiration (FNA). TESE and FNA yield spermatozoa in 30%-60% of cases depending on the technique used. 1 Patry et al. 3 recently reported one case of hypospermatogenesis (having FSH levels within the normal range), which was converted to active spermatogenesis after letrozole (Femara; Sanofi-Novartis, Paris, France) use. However, the patient remained azoospermic due to an obstruction in the epididymis that was not adequately assessed when surgery was performed. Saylam et al. 4 recently treated 17 NOA patients who had low (,10) testosterone (T)/estradiol (E2) ratios with letrozole. Four of these men showed spermatozoa in their ejaculate after 6 months of therapy.

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Azoospermia: is sample centrifugation indicated? A national survey of practice and the Oxford experience

Cited by 17 publications

References 18 publications

Natural Course of Severe Oligozoospermia in Infertile Male: Influence on Future Fertility Potential

Natural Course of Severe Oligozoospermia in Infertile Male: Influence on Future Fertility Potential

The presence of germ cells in the semen of azoospermic, cryptozoospermic and severe oligozoospermic patients: stringent flow cytometric analysis and correlations with hormonal status

Preliminary study of letrozole use for improving spermatogenesis in non-obstructive azoospermia patients with normal serum FSH

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