Sperm retrieval by conventional testicular sperm extraction for assisted reproduction in patients with Zinner syndrome

Abstract

We present data from three Caucasian men with Zinner syndrome who attended our center for the treatment of primary couple’s infertility. Each patient was scheduled for multiple conventional testicular sperm extraction (cTESE) and cryopreservation. The mean duration of infertility was 243 months. Sperm analysis confirmed absolute azoospermia. In patient 1, imaging revealed right and left testis volumes of 24 mL and 23 mL, respectively; dilatation of the right caput epididymis, corpus, and cauda; left seminal vesicle agenesis; severe right seminal vesicle hypotrophy; right renal agenesis; and left nephroptosis. The patient’s levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and total testosterone (TT) were 3.2 IU/L, 5.2 IU/L, and 22.3 nmol/L, respectively. Patient 2 exhibited right and left testis volumes of 18 mL and 16 mL, respectively; a left seminal vesicle cyst of 3228 mm; ipsilateral kidney absence; and right seminal vesicle agenesis. The patient’s levels of FSH, LH, and TT were 2.8 IU/L, 4.2 IU/L, and 14.3 nmol/L, respectively. In patient 3, ultrasound showed a testicular volume of 10 mL bilaterally, a 6546 mm left seminal vesicle cyst, right seminal vesicle enlargement, and left kidney agenesis. The patient’s levels of FSH, LH, and TT were 32.0 IU/L, 16.3 IU/L, and 9.0 nmol/L, respectively. Sperm retrieval via cTESE was successful in all patients. It may be advisable to perform cTESE to obtain fresh sperm on the day of oocyte retrieval. Sperm cryopreservation should be avoided, since thawing could further compromise the sperm quality.

A case report of rare Zinner syndrome: An ejaculatory duct cyst was present Instead of an ipsilateral seminal vesicle cyst

“…There were three very rare variations in this case, including left seminal vesicle atrophy, accompanied by the absence of the ipsilateral kidney and ureter; the right seminal vesicle was underdeveloped and adhered to the cyst wall, and both ejaculatory ducts were occluded and fused, and the ends were enlarged to form a single ejaculatory duct cyst. Cito et al [3] reported a case of ZS with ipsilateral seminal vesicle atrophy and contralateral seminal vesicle hypoplasia. Razdan et al [4] reported a ZS case of a single seminal vesicle cyst involving bilateral ejaculatory ducts.…”

“…Hofmann et al [21] considered that resecting the cyst early could help prevent an effect on the lateral reproductive tract, but the effect of these treatments on infertility was limited. Cito [3] reported that conventional testicular sperm extraction can be performed in ZS patients with azoospermia to solve fertility problems, including in one patient after resecting the seminal vesicle cyst. Assisted reproductive technology is a hope [7] [22].…”

Zinner Syndrome: The Diagnosis and Management of a Rare Urogenital Malformation

“…Despite treatment in adulthood, azoospermia often persists in patients. One study proposed that infertility in ZS stems from long-lasting obstruction of the ejaculatory duct from accumulation of seminal fluid, which creates reactive oxidative species and reproductive toxicity [ 11 ]. Therefore, it would be logical to consider for future research how early treatment may mitigate infertility later in adulthood.…”

Zinner Syndrome: Case Series and Literature Review

“…Учитывая наличие потенциальной угрозы нарушения репродуктивной функции у пациентов с обструкцией семенных путей и секреторным повреждением на фоне длительного нарушения оттока спермы, крайне важной стратегией для сохранения фертильного потенциала является криоконсервация сперматозоидов [17].…”