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This study aimed to evaluate the safety and efficacy of percutaneous epididymal and testicular sperm aspiration as a diagnostic technique to confirm sperm production and as a therapeutic technique to harvest sperms for use in the intracytoplasmic sperm injection and the indications for performing testicular biopsy in azoospermic infertile males. Thirty married patients were included in this prospective study from February 2011 to December 2012 seen in Basrah General Hospital. Their age ranged from 20 to 40 years. All patients underwent full medical examination with laboratory tests which included seminal fluid analysis, serum leutinising hormone (LH), follicular stimulating hormone (FSH), testosterone, and prolactin in addition to color Doppler ultrasonography of the scrotum. Patients with history of undescended testes, varicocele, & testicular pathology were excluded from this study. All patients showed normal physical examination with normal secondary sexual characters. The external genitalia were normal with normal sizes of their testes. The percutaneous epididymal and testicular sperm aspirations were positive in 12 out of 30 patients (40%). The rest had negative aspirations (60%). The testicular biopsy which performed in the patients with negative aspiration showed normal germinal epithelium with mature spermatozoa in only 5 patients out of 18 (28%) while the rest 13 patients had spermatogenic arrest (72%). In conclusion, percutaneous epididymal and testicular sperm aspiration has been found helpful as a diagnostic technique for patients with non-reconstructable azoospermia. It is a minimally invasive sperm retrieval technique and appears to be an effective alternative to microsurgical epididymal sperm aspiration, which is more invasive and costly. It is less invasive than testicular biopsy and preferably performed as a first step procedure in an attempt to obtain sperms for both diagnostic and therapeutic purposes.

Background Non-iatrogenic, non-traumatic obstructive azoospermia (OA) includes causes like congenital bilateral absence of vas deferens (CBAVD), blockage at rete testis, or obstruction distal to internal inguinal rings. The blockage could be potentially identified at scrotal exploration and corrected with microsurgical vasoepididymostomy (VE). The purpose of this study is to analyze patients with non-iatrogenic, non-traumatic OA who underwent scrotal exploration with or without VE anastomosis in our institution. Methods Retrospective chart review was done for patients treated from 2000 to 2015. Normal spermatogenesis confirmed by testis needle biopsy in all patients with OA. The operation method for VE anastomosis was two-stitch longitudinal intussusception technique. Patients who had prior vasectomy or history of vas deferens trauma/injury were excluded. The age, hormone profile, semen parameters, level of obstruction, semen quality at proximal epididymal cut-end and patency rates were analyzed. Results Totally 96 patients with mean age 35.4±5.6 y/o were collected. The obstruction level was at: bilateral rete testis blockage (n=17), bilateral epididymis (n=49), bilateral intra-abdominal blockage (n=7), CBAVD variants (n=3). There were 68 patients received VE anastomosis. The patency rates 6 months after operation for patients with bilateral epididymal blockage were 88%. They were 90.9% for blockage at both epididymal tails, 88.9% at epididymal body, and 83.3% at epididymal head. Motile sperm at proximal cut-end had patency rates at 80.6%, while they were 50% in cases showing only immotile sperm. The mean patency rates were 79.5% for all cases 6 months after operation. Twenty-eight percent of patients failed to proceed the correction procedure, including 25% with high or low blockage, and 3.1% with CBAVD variants. Patients with CBAVD variants showed lower semen pH (6.67±0.1, P=0.001). Conclusions For patients with non-iatrogenic non-traumatic OA receiving scrotal exploration, 28.1% are not eligible for correction. The mean patency rates for all patients 6 months after micro-anastomosis were 79.5%. They were 90.9% and 88% for cases with obstruction at bilateral epididymal tails and body respectively. Motile sperm in proximal end predicts higher patency rates.

The molecular diagnosis of Y-chromosomal microdeletions is a common routine genetic test which is part of the diagnostic workup of azoospermic and severe oligozoospermic men. Since 1999, the European Academy of Andrology (EAA) and the European Molecular Genetics Quality Network (EMQN) have been actively involved in supporting the improvement of the quality of the diagnostic assays by publication of the laboratory guidelines for molecular diagnosis of Y-chromosomal microdeletions and by offering external quality assessment trials. The present revision of the 2004 laboratory guidelines summarizes all the clinical novelties related to the Y chromosome (classic, partial and gene-specific deletions, genotype-phenotype correlations, methodological issues) and provides an update on the results of the quality control programme. These aspects also reflect the consensus of a large group of specialists present at a round table session during the recent Florence-Utah-Symposium on 'Genetics of male infertility' (Florence, 19-21 September, 2013). During the last 10 years the gr/gr deletion has been demonstrated as a significant risk factor for impaired sperm production. However, the screening for this deletion type in the routine diagnostic setting is still a debated issue among experts. The original basic protocol based on two multiplex polymerase chain reactions remains fully valid and appropriate for accurate diagnosis of complete AZF deletions and it requires only a minor modification in populations with a specific Y chromosome background. However, in light of novel data on genotype-phenotype correlations, the extension analysis for the AZFa and AZFb deletions is now routinely recommended. Novel methods and kits with excessively high number of markers do not improve the sensitivity of the test, may even complicate the interpretation of the results and are not recommended. Annual participation in an external quality control programme is strongly encouraged. The 12-year experience with the EMQN/EAA scheme has shown a steep decline in diagnostic (genotyping) error rate and a simultaneous improvement on reporting practice.

Objective To evaluate whether defective cyclic adenosine monophosphate responsive element modulator (CREM) expression is the causative factor of spermatid maturation arrest (SMA). Design Comparative evaluation of the testicular histology in patients with SMA or normal spermatogenesis. Setting University clinic of andrology. Patient(s) Azoospermic patients undergoing testicular biopsy. Intervention(s) None. Main outcome measure(s) Expression of CREMτ in quantitative immunohistochemistry analysis of testicular biopsy samples. Result(s) Regular CREM expression was observed in the tubules with round, but not elongated, spermatids of patients with SMA (n = 9). Quantitative analysis showed that round spermatids of patients with SMA had a staining intensity similar to that observed in controls (n = 7). Conclusion(s) Lack of spermatid elongation was not due to defective CREM expression. Therefore, CREM did not play a pathogenetic role in the onset of SMA in humans.