[Needle aspiration testicular cytology as diagnostic parameter in the assessment with varicocele]. / La citologia testicolare per agoaspirazione come parametro diagnostico nella valutazione del soggetto affetto da varicocele.

OBJECTIVE: Varicocele is considered the most common cause of male infertility. The pathogenesis of the spermatogenetic impairment in this disease is not completely understood and the seminal patterns of patients with varicocele are different. Testicular fine-needle aspiration cytology (FNAC) in infertile men allows us to obtain many information about the type and the degree of alteration of the seminiferous tubule. MATERIALS AND METHODS: In this study, 200 infertile men with varicocele were evaluated for seminal parameters, FSH, LH and testosterone plasma concentrations. Testicular pattern was analyzed by bilateral FNAC. All patients suffered of infertility for at least two years and varicocele was the sole infertility-related pathology. According to the tubular patterns, we divided the patients into five groups, and we observed that the different tubular alterations could be present in patients with similar FSH levels and similar sperm count. Then, to verify the role of tubular pattern as prognostic factor for the correction of varicocele, we studied 70 men, performing seminal analysis and hormonal evaluation six months after sclerotherapy. RESULTS: We found an increasing in sperm count and in other seminal parameters after the sclerotherapy (motility, normal morphology...) only in patients with maturative alteration at spermatid level. This alteration of spermiogenesis seems to be reversible after sclerotherapy. CONCLUSION: In the light of these results the testicular FNAC gives important prognostic parameters in the selection of patients affected by varicocele for sclerotherapy.

Suppression of the high endogenous levels of plasma FSH in infertile men are associated with improved Sertoli cell function as reflected by elevated levels of plasma inhibin B.

BACKGROUND: In vitro continuous stimulation of Sertoli cells with FSH leads to a desensitization of these cells to FSH action. To evaluate the presence of a desensitization of FSH receptor on Sertoli cells in vivo, we performed a controlled clinical study in 97 men affected by severe oligozoospermia. METHODS: On the basis of FSH and inhibin B plasma concentrations, these subjects were divided into three groups: group A, 33 subjects with high FSH and low inhibin B plasma levels; group B, 32 subjects with high FSH plasma levels and inhibin B concentrations at the lower limit of the normal range; and group C, 32 subjects with normal FSH and inhibin B plasma levels. Patients with high FSH plasma levels (groups A and B) were prospectively randomized into two subgroups, called A1, A2, B1 and B2. Patients of groups A1 and B1 were treated with a GnRH agonist, leuprolide acetate, to induce a hypogonadotrophic state and then were treated with recombinant human FSH (r-hFSH; 100 IU/day) and hCG (2000 IU/twice a week) for 2 months. Subjects of groups A2, B2 and C were treated only with r-hFSH for the same period. RESULTS: In patients of group A1, inhibin B remained unmodified during the whole period of study, whereas in subjects of group B1, we observed a significant reduction of this hormone during the hypogonadotrophic period and then an increase of inhibin B plasma levels that were higher that those observed before therapy. In patients of groups A2 and B2, FSH treatment did not induce a significant increase in inhibin B concentrations. In patients of group C, FSH induced a significant increase in inhibin B plasma levels. CONCLUSIONS: In infertile men, suppression of the high endogenous levels of plasma FSH associated with much lower exogenous FSH levels is able to evoke higher inhibin B production, which may indicate improved Sertoli cell function and the possibility that this could have a positive effect on spermatogenesis.