Clinical, genetic, biochemical, and testicular biopsy findings among 1,213 men evaluated for infertility
Pathologic findings could explain male-factor infertility in two-thirds of infertile men. Notably, Leydig cell insufficiency was frequently detected in otherwise idiopathic infertile men.
Volume 107, Issue 1, Pages 74-82
Authors:
Inge Ahlmann Olesen, M.D., Ph.D., Anna-Maria Andersson, Ph.D., Lise Aksglaede, M.D., Ph.D., Niels Erik Skakkebaek, M.D., D.M.Sc., Ewa Rajpert–de Meyts, M.D., D.M.Sc., Niels Joergensen, M.D., Ph.D., Anders Juul, M.D., D.M.Sc.
Abstract:
Objective
To study the pathologic findings among men evaluated for infertility.
Design
A retrospective, single-center, cross-sectional study.
Setting
University hospital–based research center.
Participant(s)
We included data from 1,213 medical records from infertile men referred for diagnostic work-up from 2005 to 2009.
Interventions(s)
None.
Main Outcome Measure(s)
Health history, clinical findings, chromosome/genetic aberrations, semen quality, reproductive hormones.
Result(s)
In total, 64.4% of the infertile men had one or more reproductive disorders or factors influencing fertility, leaving 35.6% diagnosed as idiopathic infertile. In 244 patients (20%), including seven cases of testicular cancer and/or germ cell neoplasia in situ, a pathologic finding was first detected during diagnostic work-up. Two hundred four patients (16.8%) had a history of cryptorchidism and 154 (12.7%) of varicocele (grade 2 and 3). Thirty-three patients had chromosomal abnormalities, including 16 with sex chromosome abnormalities (11 with 47,XXY). Y-chromosome microdeletions were detected in 65 patients (5.4%). One hundred thirty-three had azoospermia, of which 58 had testicular biopsy findings (Sertoli cell–only syndrome: n = 23; spermatogenic arrest: n = 7; impaired spermatogenesis and atrophy: n = 28). Additionally, in idiopathic infertile men and infertile men with additional symptoms of testicular dysgenesis syndrome, 22.5% presented with a degree of Leydig cell insufficiency, with the highest frequency (33.1%) among patients with sperm concentration <5 million/mL.
Conclusion(s)
We report pathologic findings that could explain the male-factor infertility in two-thirds of infertile men referred to our center. Thus, male infertility may be a sign of an underlying disease that warrants attention.
1 Comments
This article provides useful information that we can pass along to our fertility patients, and also reinforces the need for a full hormonal workup. Perhaps in the future LH testing (in addition to FSH and T) will be in the diagnostic panel recommendations.