Early Versus Late Maturation Arrest: Reproductive Outcomes of Testicular Failure

Weedin, John; Bennett, R. C.; Fenig, David M.; Lamb, Dolores J.; Lipshultz, Larry I.

doi:10.1016/j.juro.2011.03.156

Cited by 48 publications

(39 citation statements)

References 27 publications

(31 reference statements)

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“…Although studies are lacking to assess the early phase of spermatogenesis up to pachytene, earlier studies showed up to 50% reduced recombination rates in cases with MA (Gonsalves et al 2004, Egozcue et al 2005. Similarily, a sixfold increased frequency of genetic abnormalities was observed in cases of MA compared with Hyp (Weedin et al 2011).…”

Section: Discussionmentioning

confidence: 78%

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Role of compensatory meiosis mechanisms in human spermatogenesis

Borgers¹,

Wolter²,

Hentrich³

et al. 2014

Reproduction

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Disturbances of checkpoints in distinct stages of spermatogenesis (mitosis, meiosis, and spermiogenesis) contribute to impaired spermatogenesis; however, the efficiency of meiotic entry has not been investigated in more detail. In this study, we analyzed azoospermic patients with defined spermatogenic defects by the use of octamer-binding protein 2 for type A spermatogonia, sarcoma antigen 1 for mitosis-meiosis transition and SMAD3 for pachytene spermatocytes. Especially patients with maturation arrest (MA) at the level of primary spermatocytes showed significantly reduced numbers of spermatogonia compared with patients with histologically intact spermatogenesis or patients with hypospermatogenesis (Hyp). For a detailed individual classification of the patients, we distinguished between 'high efficiency of meiotic entry' (high numbers of pachytene spermatocytes) and 'low efficiency of meiotic entry' (low numbers of pachytene spermatocytes). Only patients with histologically normal spermatogenesis (Nsp) and patients with Hyp showed normal numbers of spermatogonia and a high efficiency of meiotic entry. Of note, only patients with histologically Nsp or patients with Hyp could compensate low numbers of spermatogonia with a high efficiency of meiotic entry. In contrast, patients with MA always showed a low efficiency of meiotic entry. This is the first report on patients with impaired spermatogenesis, showing that half of the patients with Hyp but all patients with MA cannot compensate reduced numbers in spermatogonia with a highly efficient meiosis. Thus, we suggest that compensatory meiosis mechanisms in human spermatogenesis exist.

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Section: Discussionmentioning

confidence: 78%

“…In addition, in cases with MA reduced recombination rates (up to 50%) were found (Gonsalves et al 2004, Egozcue et al 2005 and an increased frequency of genetic abnormalities (Weedin et al 2011).…”

Section: Introductionmentioning

confidence: 94%

Role of compensatory meiosis mechanisms in human spermatogenesis

Borgers¹,

Wolter²,

Hentrich³

et al. 2014

Reproduction

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“…In our study, multiple TESE, including contralateral sampling in hypospermatogenesis and in adverse histopathology patterns (MA and SCO), was associated with a higher SRR (Table 3). According to Weedin et al, 2011, when subjects with uniform MA were subcategorized in early and late MA, the latter reported a significantly higher SRR during c-TESE (p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Conventional testicular sperm extraction (TESE) and non‐obstructive azoospermia: is there still a chance in the era of microdissection TESE? Results from a single non‐academic community hospital

et al. 2016

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SUMMARYSpermatozoa can be retrieved in non-obstructive azoospermia (NOA) patients despite the absence of ejaculated spermatozoa in their semen because of the presence of isolated foci with active spermatogenesis. Conventional testicular sperm extraction (c-TESE) in patients with NOA has been partially replaced by micro-TESE. It is still under debate the problem regarding the higher costs related to micro-TESE when compared with c-TESE. In this study, we evaluated sperm retrieval rate (SRR) of c-TESE in naive NOA patients. Sixty-three NOA patients were referred to our centre for a c-TESE. For every subject, we collected demographic data, cause of infertility, time to first infertility diagnosis, serum levels of LH, FSH, total testosterone and prolactin. A statistical analysis was conducted to correlate all the clinical variables, the histology and the Johnsen score with the SRR. Sixty-three consecutive NOA patients with a mean age of 37.3 years were included. The positive SRR was 47.6%. No statistical differences were observed between positive vs. negative SRR regarding mean FSH (17.12 vs. 19.03 mUI/mL; p = 0.72), and LH (9.72 vs. 6.92 mUI/mL; p = 0.39) values. Interestingly, we found a statistically significant difference in terms of time to first infertility diagnosis (+SRR vs. ÀSRR; 44.5 vs. 57 months; p = 0.02) and regarding to age (+SSR vs. ÀSRR; 40.1 vs. 35.3; p = 0.04). There was a statistically significant decrease in SRRs with the decline in testicular histopathology from hypospermatogenesis to maturation arrest, and SCO. The mean Johnsen score was 5.9 with a mean percentage of Johnsen score ≥8 tubules equal to 19%. The overall pregnancy rate was 26.6%. In our prospective cohort of patients successful SRR with c-TESE was 47.6%. Lower costs and high reproducibility of this technique still support this procedure as an actual reliable option in NOA patients for sperm retrieval.

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“…We reconciled the absence of diagnostic biopsies by subcategorizing our population into NOA with an elevated FSH, as can be seen in Sertoli Cell Only syndrome and early maturation arrest, and NOA with normal FSH which is most often associated with late maturation arrest as suggested by Lipshultz [25] . He found that men with late maturation arrest, in which spermatids are present, had decreased FSH and a higher TESE sperm retrieval rate compared to those with early maturation arrest, in which primarily spermatogonia or spermatocytes were seen [25] .…”

Section: Discussionmentioning

confidence: 99%

“…He found that men with late maturation arrest, in which spermatids are present, had decreased FSH and a higher TESE sperm retrieval rate compared to those with early maturation arrest, in which primarily spermatogonia or spermatocytes were seen [25] .…”

Section: Discussionmentioning

confidence: 99%

Testicular sperm aspiration in men with presumed non-obstructive azoospermia: Analysis of FSH level as a predictor of successful sperm retrieval

Chow

Levine

2017

JGS

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Objective: To evaluate the sperm-retrieval rate (SRR) of testicular sperm aspiration (TESA) for men with presumed non-obstructive azoospermia (NOA) without prior genetic testing or testicular biopsies and to examine the correlation of successful sperm retrieval and FSH level. Patients and Methods:The complete records of 148 azoospermic men without clinical evidence of obstructive etiologies who underwent TESA from 1999 -2016 were reviewed. Preoperative diagnostic biopsies were not obtained and thus men with presumed NOA were defined as having no evidence of obstruction by history or physical examination. Preoperative FSH and testosterone were obtained for all patients. Two subgroups of NOA were evaluated (Group 1 with FSH > 10 IU/L and Group 2 with FSH ≤ 10). Results: Of our 148 patients, we identified 66 (45%) in Group 1 and 82 (55%) in Group 2. Sperm was successfully obtained from 19/66 (28.7%) in Group 1 and 56/82 (68%) in Group 2. Average FSH for Group 1 and Group 2 were 20.4 (10 -66) IU/L and 4.6 (1.1 -9.4) IU/L respectively. There were no postoperative adverse events including prolonged pain, infection, hematoma, hydrocele or testicular atrophy. Conclusion: TESA appears to offer a reasonably high likelihood of viable sperm retrieval in men with NOA. Given the higher level of SRR for men with presumed NOA with normal range of FSH (≤ 10 IU/L), we recommend that TESA should be considered the initial approach to retrieve sperm in this population as it is a quicker, easier, less invasive and likely a less costly approach to micro-TESE.

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Early Versus Late Maturation Arrest: Reproductive Outcomes of Testicular Failure

Cited by 48 publications

References 27 publications

Role of compensatory meiosis mechanisms in human spermatogenesis

Role of compensatory meiosis mechanisms in human spermatogenesis

Conventional testicular sperm extraction (TESE) and non‐obstructive azoospermia: is there still a chance in the era of microdissection TESE? Results from a single non‐academic community hospital

Testicular sperm aspiration in men with presumed non-obstructive azoospermia: Analysis of FSH level as a predictor of successful sperm retrieval

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