spermatogenic failure 34

Spermatogenic failure, also known as non-obstructive azoospermia (NOA), is a condition where the testes are unable to produce sperm due to various reasons.

• Definition: Spermatogenic failure refers to the disruption of spermatogenesis, which is the process by which immature cells in the testes develop into mature spermatozoa.
• Causes: The causes of spermatogenic failure can be varied and include genetic mutations, hormonal imbalances, environmental factors, and other medical conditions. [1][2]
• Symptoms: Men with spermatogenic failure may experience infertility, low sperm count, or absence of sperm in the semen.
• Types: There are several types of spermatogenic failure, including:
  • Spermatogenic arrest: This is a condition where the development of sperm is arrested at a specific stage. [11]
  • Non-obstructive azoospermia (NOA): This is a condition where there is no sperm in the semen due to problems with spermatogenesis.
• Treatment: Treatment for spermatogenic failure depends on the underlying cause and may include medications, hormone replacement therapy, or assisted reproductive technologies such as IVF. [5]

References:

[1] Spermatogenic failure-64 (SPGF64) is characterized by male infertility due to oligoasthenoteratozoospermia or nonobstructive azoospermia.

[2] Spermatogenic arrest is also not a specific diagnosis for primary exocrine testicular failure, but a histopathological description of the interruption of normal germ cell maturation at the level of a specific cell type including that of spermatogonial arrest, spermatocyte arrest, and spermatid arrest.

[5] In up to 55% of couples seeking medical attention, the male partner is diagnosed with spermatogenic failure, defined as one or more semen parameters falling below reference values.

Diagnosing Spermatogenic Failure: A Comprehensive Approach

Spermatogenic failure, also known as testicular or spermatogenic failure, is a severe form of male infertility characterized by severely impaired spermatogenesis resulting in azoospermia (no sperm) or severe oligozoospermia (very low sperm count). Diagnosing this condition requires a thorough evaluation of various tests and examinations. Here are some diagnostic tests used to diagnose spermatogenic failure:

• Semen Analysis: A semen analysis is one of the primary tests healthcare providers use to help diagnose male infertility, including spermatogenic failure [3]. This test evaluates the quantity and quality of sperm in the ejaculate.
• FSH (Follicle-Stimulating Hormone) Levels: FSH levels are usually less than approximately 7.6 IU/L in cases of spermatogenic failure [2]. Elevated FSH levels can indicate that the problem lies with sperm production rather than obstruction.
• Testicular Biopsy: A testicular biopsy may be performed to determine the histological diagnosis of azoospermia and for the extraction of spermatozoa to be used in assisted reproductive technologies [7, 8].
• Genetic Testing: Genetic testing can help identify underlying genetic causes of spermatogenic failure. While some genetic tests, such as karyotyping, YCMD screening, and CFTR sequencing, may provide clearer prognoses and treatment options for future fertility [14], many men have no known cause.
• Hormonal Evaluation: Hormonal evaluation, including testosterone levels, can help determine if the problem lies with endocrine failure leading to impaired spermatogenesis.

These diagnostic tests are essential in determining the underlying cause of spermatogenic failure and guiding treatment decisions. A comprehensive approach that includes a combination of these tests is crucial for accurate diagnosis and effective management of this condition.

References:

[1] DL Andrade, et al. (2021) - [Context 1] [2] DL Andrade, et al. (2021) - [Context 2] [3] SC Sikka, et al. (2016) - [Context 3] [7] SC Sikka, et al. (2016) - [Context 7] [8] SC Sikka, et al. (2016) - [Context 8] [14] SC Sikka, et al. (2016) - [Context 14]

Treatment Options for Spermatogenic Failure

Spermatogenic failure, also known as nonobstructive azoospermia (NOA), is a condition where the testes are unable to produce sperm. While there is no cure for this condition, various drug treatments have been explored to stimulate spermatogenesis.

Hormonal Stimulation

Some studies have shown that hormonal stimulation can help boost intra-testicular testosterone levels and induce spermatogenesis in men with NOA (1). Gonadotropins, such as human chorionic gonadotropin (hCG) and follicle-stimulating hormone (FSH), have been used to stimulate testicular function and promote sperm production (2).

Gonadotropin Treatment

Treatment with hCG with or without rhFSH is often called "gonadotropin treatment." It involves getting injections of hCG three times per week for a period of time, which can help stimulate spermatogenesis (8). However, the effectiveness of this treatment varies from person to person.

Other Treatment Options

High-dose androgen therapy has also been used to suppress spermatogenesis for a time, with the goal of allowing the testes to recover and produce sperm again (9). However, this treatment is not commonly used due to its potential side effects.

Current Literature

A recent article summarized the current literature regarding azoospermia caused by spermatogenic failure, including medical therapies such as hormonal manipulation to induce spermatogenesis (15).

It's essential to note that while these treatments may show promise, they are not universally effective and should be discussed with a healthcare professional before starting any treatment plan.

References:

[1] - 8 [2] - 6 [8] - 8 [9] - 9 [15] - 15

Differential Diagnosis of Spermatogenic Failure

Spermatogenic failure, also known as non-obstructive azoospermia (NOA), is a condition where the testes are unable to produce sperm. The differential diagnosis of spermatogenic failure involves identifying the underlying causes of this condition.

Causes of Spermatogenic Failure

• Genetic Abnormalities: Genetic anomalies, such as Klinefelter syndrome (47,XXY), are known to affect about 15% of infertile patients with azoospermia or severe oligozoospermia [12].
• Hypogonadotropic Hypogonadism: This condition is characterized by low levels of testosterone and FSH, leading to impaired spermatogenesis [7].
• Cryptorchidism: Undescended testes can lead to impaired spermatogenesis due to inadequate temperature regulation [7].
• Delayed Puberty: Delayed puberty can result in impaired spermatogenesis due to hormonal imbalances [7].
• Male Pseudohermaphroditism: This condition is characterized by the presence of both male and female reproductive organs, leading to impaired spermatogenesis [7].

Diagnostic Work-up

A thorough diagnostic work-up is essential to determine the underlying cause of spermatogenic failure. This includes:

• Semen Analysis: Semen analysis should be accompanied by measurement of serum hormone levels of at least the pituitary-produced hormones (FSH, LH, and testosterone) [14].
• Genetic Testing: Genetic testing can help identify genetic abnormalities that may be contributing to spermatogenic failure [12].
• Imaging Studies: Imaging studies, such as ultrasound or MRI, can help evaluate the testicular anatomy and detect any abnormalities [5].

Management

The management of spermatogenic failure depends on the underlying cause. In some cases, treatment with medications or surgery may be necessary to address the underlying condition.

References:

[7] by LF Pisani · 2008 · Cited by 90 — [12] by SC Esteves · 2015 · Cited by 16 — [14] a Descriptive diagnoses according to semen analyses of 26,091 men in infertile couples who attended the Centre of Reproductive Medicine and Andrology (CeRA), Münster over the last 30 years.b Clinical diagnoses in the same men.Data from Androbase ©, the clinical patient database []