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Objective: To determine if there are areas of major and minor perfusion in a single testicle, and if the quality and quantity of sperm are correlated with the level of perfusion, we collected testicular tissue from areas with different levels of perfusion., Design: Controlled clinical study., Setting: Consecutive patients with azoospermia., Patient(s): Patients with azoospermia undergoing testicular sperm extraction (TESE) biopsy for the retrieval of sperm to be used in an assisted reproduction program., Intervention(s): Perfusion mapping was performed with the use of color Doppler ultrasound. Areas with different levels of perfusion were marked with needles. After incision with radiofrequency cutting, the exposed tissue was examined with a laser Doppler flowmeter, and biopsies were taken for TESE and histology. Sperm were analyzed using World Health Organization criteria, and prepared for intracytoplasmic sperm injection (ICSI)., Main Outcome Measure(s): Correlation of sperm quality and quantity in testicular-tissue biopsies, with tissue-perfusion units (TPU) measured by laser Doppler flowmeter., Result(s): From 40 biopsies taken from 20 testicles of 12 patients, tissue was analyzed for sperm quality and quantity. Sperm quality was highest in areas of high tissue perfusion. In areas of 70 TPU, 72.3% progressive sperm were detected, whereas in areas of 10 TPU, only 13.3% progressive sperm and elevated numbers of precursor cells could be observed. The number of motile sperm isolated from tissue samples correlated well with the intensity of tissue perfusion., Conclusion(s): We have shown for the first time that in patients suffering from azoospermia, sperm quality and quantity depend on tissue perfusion within the testicle.

OBJECTIVE To investigate the value of the resistive index (RI) of intratesticular arteries, and to establish diagnostic criteria for normal and pathological sperm counts on the basis of quantitative colour Doppler ultrasonography (CDUS), as the assessment of the testicular RI is widely used to measure intratesticular blood flow. PATIENTS AND METHODS In all, 160 men (aged 22–43 years, 320 testicles) were prospectively investigated; 80 had a normal and 80 a pathological sperm count, the latter having mild oligoasthenozoospermia. The RI was measured using a high-frequency Doppler ultrasound probe (14 MHz), three times on each testicle at an intratesticular artery in the upper, middle and lower testicular pole. The testicular volume was also measured by US. The RI values were compared between patients with normal and pathological sperm counts, and were compared statistically with testicular volumes. In addition, blood samples were obtained for DNA extraction, chromosome analysis and hormonal evaluations. RESULTS Patients with normal sperm counts had a mean (sd) RI of 0.54 (0.05) and a mean testicular volume of 18.7 (5.2) mL, the respective values in those with pathological sperm counts were 0.68 (0.06) and 16.8 (6.0) mL, with a significantly greater RI in the latter ( P < 0.001), but with no statistically significant difference in testicular volume between the groups ( P > 0.05). CONCLUSION These preliminary data suggest that an RI of >0.6 might be suggestive of a pathological sperm count in andrological patients. The intratesticular RI as measured by CDUS seems to be a reliable indicator for routine clinical use to identify subfertile men. [ABSTRACT FROM AUTHOR]