Male infertility, risk factors and Hormonal profile and histopathological findings and Future prospective

Abstract

Background: Infertility is complex and it has multiple causes and consequences on the affected

people depending on the gender, sexual history, lifestyle, society, and cultural

background. Infertility is a global public health concern partly due to its complexity

and to difficulty in prevention, diagnosis and treatment. A couple is considered

clinically infertile only when pregnancy has not occurred after at least twelve months

of regular sexual activity without the use of contraceptives.

 The aim of our study was to determine the impact of different parameters, including testicular histopathology, on sperm count in case of reoperation in patients undergoing testicular sperm extraction.

Methods: We retrospectively analyzed patients who underwent sperm extraction for intracytoplasmic sperm injection and testicular biopsy. Histology was classified into: normal spermatogenesis; hypospermatogenesis (reduction in the number of normal spermatogenetic cells); maturation arrest (absence of the later stages of spermatogenesis); and Sertoli cell only (absence of germ cells). Semen analysis and serum FSH, LH and testosterone were measured. Patients were selected from Sindh institute of reproductive medicine with the help of an Uroandrologist. The initial step was the assessment of sub fertile men presenting in infertility clinic

Results:. There were 63% successful sperm retrieval. Higher testicular volume, lower levels of FSH, and better histological features were predictive for sperm retrieval. The same parameters and younger age were predictive factors for shorter time for sperm recovery. After multivariable analysis, younger age, better semen parameters, better histological features and lower values of FSH remained predictive for shorter time for sperm retrieval while better semen and histology remained predictive factors for successful sperm retrieval. The predictive capacity of a score obtained by summing the points assigned for selected predictors (1 point for Sertoli cell only, 0.33 points for azoospermia, 0.004 points for each FSH mIU/ml) gave an area under the ROC curve of 0.843.

Conclusions: This model can help the practitioner with counseling infertile men by reliably predicting the chance of obtaining spermatozoa with testicular sperm extraction when a repeat attempt is planned.