Vorobets M. Z., Fafula R. V., Vorobets D. Z.


About the author:

Vorobets M. Z., Fafula R. V., Vorobets D. Z.



Type of article:

Scentific article


Azoospermia is one of the most difficult to treat forms of male infertility. Depending on the causes and nature of impaired spermatogenesis, most researchers have recently divided azoospermia into obstructive (excretory) and non-obstructive (secretory). Among other pathospermias azoospermia is found in 10-15% of infertile patients. The parts of obstructive and non-obstructive forms are approximately 40% and 60% respectively. The given literary and own data devoted to modern views of the etiology, pathogenesis, diagnosis of this pathology. Particular attention is paid to the search for markers and the study of testicular biopsy specimens in order to differentiate and diagnose of azoospermia. Considering very low efficiency of the therapeutic and surgical treatment of this pathology, a further study of pathogenetic mechanisms of disease development and search for prognostic markers remains relevant. In our studies in all patients with non-obstructive azoospermia, a biopsy was performed on one side with different testicle sizes and consistency, however, with a palpator more complete testicle. Histological analysis of testicular biopsy specimens of 8 patients (28.7%) with non-obstructive azoospemia showed: testicular stromal edema, destructive changes in testosterone-producing cells, disorders of the syncytial structure spermatogenic epithelium complexes and complete absence of spermatogenesis process in some seminiferous tubules, absence of contacts between the sustentacular cells (violation of the structure of the bloodtestis barrier), erythrocyte sludges (disturbances of blood microcirculation) in blood vessels. The other 12 patients (42.8%) could observe testicular fibrosis, edema of the stroma, thinning of the wall of the seminiferous tubules, disturbance of the structure of syncytial complexes of spermatogenic epithelium, proliferation of the wall of the seminiferous tubules into their lumen, infiltration of the testicular stroma by lymphocytes. In addition, destructive changes of the seminiferous tubules, thickening of the wall of the seminiferous tubules, proliferation of the wall into the lumen of the tubule and infiltration by lymphocytes, the absence of spermatogenic cells in the lumens of seminiferous tubules were observed in 5 patients (17.8%). Testicular fibrosis and lymphocyte infiltration, proliferation of the testicular wall into the lumen of the seminiferous tubules, the absence of spermatogenic epithelium in the lumen of the seminiferous tubules, were observed in 3 patients (10.7%). Testicular biopsy is a traumatic method and obtaining testicular tissue samples is much more complicated than blood sampling for investigations. Therefore, there is a need to search for biomarkers of spermatogenesis in venous blood. The data we have obtained show that the levelof follicle-stimulating hormone (FSH) at obstructive azoospermia is 5.72±1.34 IU/l, at NОА (hypergonadotropic hypogonadism) – 21.11±2.62 IU/l, at NОА (normogonadotropic hypogonadism) – 6.21±0.52 IU/l. While level of luteinizing hormone (LH) at ОА was 5.29±0.53 IU/l, at NОА (hypergonadotropic hypogonadism) – 12.52±1.63 IU/l, at NОА (normogonadotropic hypogonadism) – 4.81±0.52 IU/l. Regarding to the level of the total testosterone, at OA it was 519.9 ±52.0 ng/l, at NОА (hypergonadotropic hypogonadism) – 365.5±43.0 ng/l, at NОА (normogonadotropic hypogonadism) – 408.8±51.0 ng/l. Patients with hypogonadism both congenital and acquired are prescribed hormone therapy with gonadotropins. However, at present, hormone therapy is empirical, is selected individually, and its effectiveness is only achieved by increasing the level of endogenous testosterone. Regarding inhibin B, in our studies of normozoospermia the serum level of this hormone was 217.3±50.8 pg/ml. At NOA, the level of inhibin B was lower than the norm in 2.7 times and was 59.8±19.6 pg/ml. Most experiments indicate that inhibin B secretion is directly dependent on FSH levels and spermatogenesis. Low levels of inhibin B and high levels of FSH are observed in infertile men. Inhibin B 80 pg/ml indicates a man’s reproductive problems. These data directly correlate with testicular function. Inhibin B concentration is higher in men who do not have conception problems. In patients who underwent castration, inhibin B was not detected. It strongly confirms that inhibin B reflects the function of the testes, in particular Sertoli cells. There is a relationship between inhibin B levels, FSH levels and testicular function. It is shown that serum inhibin B level reflects the functional state of spermatogenesis, since it participates in the feedback of the hypothalamic-pituitary-testicular axis. The received own and literary data show that the most modern classification of forms of azoospermia is its division into obstructive (excretory) and non-obstructive (secretory). Histological analysis of testicular biopsy specimens is the most informative method for the diagnosis and differentiation of azoospermia, however, it is also the most traumatic. A search for biochemical markers of azoospermia showed that inhibin B is currently the most informative for diagnosis at non-obstructive form of this pathology. Assessment of inhibin B level is in many cases is an alternative to biopsy for the differential diagnostics of male infertility.


spermatogenesis, obstructive azoospermia, non-obstructive azoospermia, biopsy, testes, inhibin B, Sertoli cells, Leydig cells.


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Publication of the article:

«Bulletin of problems biology and medicine» Issue 1 (155), 2020 year, 26-33 pages, index UDK 616.697-07-091.8