Modern Views on Pathogenesis and Markers of Men’s Azoospermia

Vorobets, M. Z.; Фафула, Р. В.; Vorobets, D. Z.

doi:10.29254/2077-4214-2020-1-155-26-33

Cited by 3 publications

(4 citation statements)

References 36 publications

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“…Depending on the nature and causes of impaired spermatogenesis, azoospermia is divided into obstructive (excretory, OA) and non-obstructive (secretory, NOA) [11,21,25]. In male infertility, azoospermia is detected in 10-15% of cases, while the share of obstructive and non-1 (25) січень-березнь, 2023 «Art of Medicine» obstructive forms is approximately 40 and 60%, respectively [11,21,26].…”

Section: Introductionmentioning

confidence: 99%

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Morpho-Functional Characteristics of the Testicles of Men With Different Forms of Pathospermia

Vorobets¹,

Melnyk²,

Фафула³

et al. 2023

Scientific and practical journal

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The most difficult form of male infertility to treat is azoospermia. It is identified as a complete absence of sperm in the ejaculate. Depending on the nature and causes of impaired spermatogenesis, azoospermia is divided into obstructive (excretory, OA) and non-obstructive (secretory, NOA). Testicular biopsy is the most effective method of diagnosis and a component of possible treatment for azoospermia. It is the only objective method of differential diagnosis between non-obstructive and obstructive forms of azoospermia. The aim: histological analysis of testicular biopsies of men with various forms of azoospermia. Мaterials and Methods. 78 infertile men with azoospermia were examined. They were divided into two groups: the first group, men with NOA (n = 28); the second group, men with OA (n = 50). The biopsy was preceded by a mandatory ultrasound diagnosis of the portal system. The biopsy was performed using the method of open operative access. Biopsies were mostly taken from the more palpable testicle or from both testicles. Biopsies were fixed in buffered 10% formalin (pH 7.2). After 1 day, they were dehydrated in 70% ethanol and embedded in paraffin. For histological studies, sections with a thickness of 5 μm were stained with hematoxylin and eosin. Biopsies were evaluated in accordance with previously described methods. Results. Histological analysis of testicular biopsies from 28.7% of patients with a non-obstructive form of azoospermia showed swelling of the testicular stroma, destructive changes in testosterone-producing cells, disruption of the structure of the syncytial complexes of the spermatogenic epithelium, and the complete absence of the process of spermatogenesis in individual tortuous seminiferous tubules, the absence of contacts between sustentocytes, and in erythrocyte sludge in the lumen of vessels. 42.8% of patients had fibrosis of the testicular stroma, stroma swelling, thinning of the wall of convoluted seminiferous tubules, violation of the structure of the syncytial complexes of the spermatogenic epithelium, proliferation of the wall of the convoluted seminiferous tubules into their lumen, and infiltration of the testicular stroma with lymphocytes. In 54.0% of patients with preserved spermatogenesis and an obstructive form of azoospermia, it was possible to find a history of orchoepididymitis in the anamnesis; one patient (2.0%) underwent bilateral orchopexy at the age of 5 years due to cryptorchidism; 6.0% recalled the trauma calculi in the anamnesis; and 38.0% denied any factors affecting fecundity in the anamnesis. Conclusions. The non-obstructive form of azoospermia is characterized by the following parameters: mostly a violation of the structure of the spermatogenic epithelium, a complete absence of the process of spermatogenesis in individual convoluted seminiferous tubules, a violation of the structure of the hematotesticular barrier, and a violation of blood microcirculation. The histological picture of preserved spermatogenesis is of the same type in 88.0% of patients with an obstructive form of azoospermia. In most tubules, a fixed number of cell rows is preserved, and cells of various stages of spermatogenesis are determined in them: spermatogonies, spermatocytes, a moderate number of spermatids. In the lumen of the tubules, exfoliated cells and a moderate number of spermatozoa are found.

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Section: Introductionmentioning

confidence: 99%

“…The problem is the differential diagnosis of OA and NOA. Obstructive azoospermia is the absence of spermatozoa and germinogenic cells in the ejaculate due to bilateral obstruction of the vas deferens [11,16,[19][20][21]26]. OA is less common than nonobstructive azoospermia.…”

Section: Introductionmentioning

confidence: 99%

Morpho-Functional Characteristics of the Testicles of Men With Different Forms of Pathospermia

Vorobets¹,

Melnyk²,

Фафула³

et al. 2023

Scientific and practical journal

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“…It has been found that the disruption of the DNA structure is closely related to free radical processes and oxidative stress (Aitken et al, 2014;Fafula et al, 2019). The most difficult form of male infertility to treat is azoospermia Vorobest et al, 2020;Salonia et al, 2022). Azoospermia is defined as the complete absence of spermatozoa in the ejaculate.…”

Section: Introductionmentioning

confidence: 99%

“…Azoospermia is defined as the complete absence of spermatozoa in the ejaculate. Depending on the nature and causes of impaired spermatogenesis, azoospermia is divided into obstructive (excretory, OA) and non-obstructive (secretory, NOA) Vorobest et al, 2020;Salonia et al, 2022). In male infertility, azoospermia is detected in 10-15% of cases, while the share of obstructive and non-obstructive forms is approximately 40% and 60%, respectively (Vorobest et al, 2020;Salonia et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Testicular ultrasound examination and hemodynamics of patients with azoospermia

Vorobets

Melnyk

Фафула

et al. 2022

Regul. Mech. Biosyst.

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The most difficult form of male infertility to treat is azoospermia. Azoospermia is defined as the complete absence of spermatozoa in the ejaculate. The age of the patients who underwent clinical and diagnostic studies varied between 22 and 45 years. Among 119 examined patients with azoospermia, 58.0% were diagnosed with secretory infertility. In 42.0% patients, the presence of spermatogenesis in excretory-obturational infertility was established. Among 69 patients with secretory infertility, 23 had azoospermia in the absence of spermatozoa and spermatogenic cells, which accounted for 33.3% of all patients with secretory infertility (in particular, 2 with leukocytospermia, which indicated damage to the tubular apparatus as a result of previous orchitis). In 66.6% patients, azoospermia was observed in the absence of spermatozoa, but in the presence of precursor cells of spermatogenesis. 11.5% patients out of 69 (group 1) were diagnosed with concomitant diseases. We see that arterial hypertension, diseases of the gastrointestinal tract, liver, and kidneys occur. Hereditary diseases were not detected in the examined patients. Pain of varying intensity was found in 6.7% of patients, varying degrees of testicular hypoplasia were found in 7.6%, dysuria in 13.4%, epididymitis in history 8.4%; history of epidemic mumps 6.7%; 12.6% had depression, restlessness, sleep disorders, and 21.0% had erectile dysfunction. According to clinical examination and ultrasound, chronic prostatitis is suspected in 19.2% of patients. An increase in the number of leukocytes in the blood was found in 13.2% patients. According to ultrasound, 60.5% of the patients with azoospermia had normal testicular sizes, and 39.5% had reduced testes. The volume of the testicles in the control group was 22.3 ± 2.1 cm³ on average, varying from 18.3 to 25.1 cm³. In the group with azoospermia, the volume of the testicles was on average 16.7 ± 1.7 cm³ and varied from 8.2 to 21.1 cm³, that is, the volume of the testicles in patients with azoospermia was on average 1.3 times smaller compared to normozoospermia. In the obstructive form of azoospermia, diffuse changes were detected in both testicles, probably obturational changes. Hypoplasia of the left testicle and increased echogenicity were observed in the non-obstructive form of azoospermia. The veins of the spermatic cord were moderately dilated. There was a normal amount of free fluid in the scrotum. According to elastography, the elasticity of the testicles was above normal. Obturational processes in the testicles were suspected. The hemodynamic parameters of testicular parenchymal blood flow in infertile men obtained by ultrasound dopplerography are of important diagnostic value. The average value of the linear blood flow velocity in the arteries of the parenchyma in men with normozoospermia was 0.107 ± 0.015 m/s on the right, and 0.103 ± 0.012 m/s on the left. With azoospermia, the average value of the linear velocity of blood flow on the right was 0.086 ± 0.012 m/s, and on the left – 0.084 ± 0.008 m/s. Thus, the hemodynamic indicators of the scrotum show that the most pronounced changes are found in men with azoospermia in the absence of spermatogenesis.

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Сondition of urogenital tract microbiotes and pro- and antioxidant system in male azoospermia

Vorobets

Melnyk

Коваленко

et al. 2021

Regul. Mech. Biosyst.

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Over the past 20 years, there has been a clear trend to increase in the number of infertile men in Ukraine, their percentage reaches 50% in infertile couples. There is a significant percentage of male infertility caused by azoospermia – the lack of sperm in the ejaculate. In male infertility, azoospermia is found in 10–15% of patients, among other forms of pathospermia. Given the ambiguity of ideas about the etiology, pathogenesis and treatment and diagnostic approaches for various types of infertility, it remains important to clarify the relationship of urogenital infections with the regulatory systems of cells, including the state of the pro- and antioxidant system and the search for additional markers. 119 patients with various forms of azoospermia were examined. All patients underwent the following studies: spermogram, infectious screening, inhibin B, lipid peroxidation, activity of enzymes of the glutathione antioxidant system in sperm plasma and blood serum. Infectious screening included analysis of urethral secretions, bacteriological examination of sperm or prostate secretion, assessment of the species and quantitative composition of the microflora of the male urogenital tract. According to the results of spermogram and other diagnostic methods, a non-obstructive form of azoospermia was detected in 69 patients. In obstructive azoospermia, ejaculate as such was absent. It is suggested that inhibin B may be an important medical diagnostic test for azoospermia. As a result of the conducted researches the importance of determining the concentration of inhibin B as a marker of azoospermia was demonstrated and a negative correlation of moderate strength between the content of inhibin B and testosterone level in the plasma of men with non-obstructive azoospermia was revealed. It was found that Ureaplasma pervum and Ureaplasma urealyticum infect the male genitourinary system to the greatest extent among a number of microorganisms, both in non-obstructive and obstructive forms of azoospermia. Enterococcus faecalis is more pronounced in the sperm fluid in the non-obstructive form of azoospermia and prostate secreton in the obstructive form of azoospermia. In the non-obstructive form of azoospermia in the seminal plasma and serum, the processes of lipid peroxidation intensify, the concentration of reduced glutathione decreases and the activities of the enzymes of the glutathione antioxidant system (glutathione peroxidase and glutathione transferase) decrease. It can be considered that an important diagnostic test for the nonobstructive form of azoospermia is the ratio of reduced glutathione to oxidized glutathione in sperm plasma.

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Modern Views on Pathogenesis and Markers of Men’s Azoospermia

Cited by 3 publications

References 36 publications

Morpho-Functional Characteristics of the Testicles of Men With Different Forms of Pathospermia

Morpho-Functional Characteristics of the Testicles of Men With Different Forms of Pathospermia

Testicular ultrasound examination and hemodynamics of patients with azoospermia

Сondition of urogenital tract microbiotes and pro- and antioxidant system in male azoospermia

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