Sertoli cell only syndrome induced by a varicocele

Abstract

A case is reported which describes the severity of testicular histological damage that can be induced by a high-grade varicocele in a male with secondary infertility. A chart review of a patient's case was performed. A 34-year-old male with a three-and-a-half-year-old son who was conceived spontaneously with timed intercourse, with a grade three left varicocele, who's semen parameters progressed to non-obstructive azoospermia (NOA). He did not regain sperm in the ejaculate three or six months post left subinguinal microsurgical varicocele repair. He underwent bilateral microdissection testicular sperm extraction (microTESE) without identification of sperm in the testicular samples. A testicular biopsy from the time of microTESE revealed a Sertoli cell only pattern. A high-grade varicocele has the potential to induce sufficient testicular damage to result in the most severe testicular histological architecture associated with nonobstructive azoospermia (NOA), Sertoli cell only syndrome (SCOS).

The benefits of varicocele repair for achieving pregnancy in male infertility: A systematic review and meta-analysis

“…showed that there is a 10–50% chance of sperm-return in patients with NOA after varicocele repair. This study also revealed that a high-grade varicocele might cause the most severe form of NOA (i.e., Sertoli cell only syndrome) over time [ 48 ]. Therefore, the timing of varicocele repair could play a crucial role in couples seeking to have a biological child.…”

Sertoli Cells Only Syndrome - Case Report

“…In general, the patient is male with normal external genitalia, well-developed secondary sexual characteristics and azoospermia ( Hanmayyagari et al ., 2015 ). It is one of the most serious forms of non-obstructive azoospermia, and may be associated with other clinical manifestations in some cases ( Kavoussi et al ., 2019 ; Paduch et al ., 2019 ). However, the main complaint that makes the couple seek medical advice is the unsuccessful attempt at pregnancy ( Kim et al ., 2015 ).…”

“…Leydig’s interstitial cells are present and produce testosterone normally. It can be primary, characterized by a reduction in growth factors GDNF, FGF8 and BMP4 - that at low levels do not induce replication and the stimulus for the differentiation of spermatogenic stem cells into spermatogonia or, secondary, as Klinefelter’s Syndrome, exposure to toxins or chemicals, viruses, radiotherapy, trauma and varicocele ( Gat et al ., 2019 ; Behre et al ., 2015 ; Kavoussi et al ., 2019 ; Paduch et al ., 2019 ; Stouffs et al ., 2016 ; Nistal et al ., 1990 ).…”

“…In general, the complaint is infertility ( Jain & Halder, 2012 ). The physical examination is not enlightening, and, in some cases, there may be testicular atrophy (10-20 mL in volume) or bilateral varicocele, without other important findings ( Gat et al ., 2010 ; Kavoussi et al ., 2019 ; Matsumoto & Bremner, 2016 ). There are no signs of feminization, such as gynecomastia, and all male characteristics are preserved - Hanmayyagari et al ., 2015 .…”

“…The reproductive prognosis of affected patients is quite poor, as there is no way to treat the condition itself ( Hanmayyagari et al ., 2015 ; Kavoussi et al ., 2019 ; Paulis et al ., 2017 ). In most cases, donor’s semen is used when the couple is interested in pregnancy ( Hanmayyagari et al ., 2015 ).…”