Testis & paratestis



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Last staff update: 29 November 2022

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PubMed Search: Infertility testis and epididymis

Turki Al-Hussain, M.D.
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Cite this page: Al-Hussain T. Infertility. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testisinfertility.html. Accessed September 21st, 2023.
Definition / general
  • All stages of spermatogenesis present but reduced to a varying degree
  • Includes the mixed pattern with some tubules showing Sertoli cells only or hyaline sclerosis with others tubules containing complete spermatogenesis
  • Mild if changes in occasional tubules; severe if significant reductions in all tubules, moderate in between
  • Often is thickening of tunica propria, interstitial fibrosis, tubular sclerosis, germ cell disorganization and sloughing into lumina
  • Many causes of infertility induce hypospermatogenesis, such as diabetes mellitus, toxins, excess heat, varicocele, hypothyroidism, irradiation and others

Additional references
Definition / general
  • Causes: pretesticular, testicular, posttesticular
  • Pretesticular: extragonadal endocrine disorders (hypothalamic, pituitary, adrenal); includes elevated prolactin levels (Arch Pathol Lab Med 1984;108:35)
  • Testicular: little treatment currently available
  • Posttesticular: duct obstruction (congenital, inflammatory, postsurgical); surgical treatment often successful since spermatogenesis is normal
    • Impaired sperm motility due to epididymal or immunologic factors is considered posttesticular
  • Evaluation: history and physical examination, semen analysis, white blood cell count in semen, detection of antisperm antibodies, sperm function tests (cervical mucus interaction, ova penetration, hemizonal assay)
  • Testicular biopsy is helpful for azoospermia without endocrine abnormalities
  • RNA binding motif: nuclear immunostain identifies spermatogenesis in biopsies that appear to be Sertoli cell only (Hum Pathol 2001;32:36)

Additional references
Maturation arrest
Definition / general
  • Complete maturation arrest: germ cell maturity ceases at a specific point frequently at primary spermatocyte level; sperm counts usually zero
  • Incomplete maturation arrest: similar to complete but a few late spermatids are present in a few seminiferous tubules, some prefer the term hypospermatogenesis instead of incomplete maturation arrest; patients are usually oligospermic (Arch Pathol Lab Med 2010;134:1197)
  • Same etiologies as hypospermatogenesis (diabetes mellitus, toxins, excess heat, varicocele, hypothyroidism, irradiation); also postpubertal gonadotropin deficiency, alkylating agents
  • Nonzero sperm counts indicate late spermatids are present somewhere in testis, although perhaps not in area biopsied
  • Patients with early maturation arrest have a greater incidence of genetic anomalies and are more likely to have worse reproductive outcomes than are patients with late maturation arrest (Urology 2012;80:826)

Microscopic (histologic) description
  • Numerous spermatogonia, few spermatocytes, no mature spermatozoa
  • Sertoli cells prominent since reduced germ cells
  • Tubules often contain degenerated cells with irregular dense nuclei

Microscopic (histologic) images

Contributed by Asmaa Gaber Abdou, M.D.

Various images

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