Research ArticleINFERTILITY

Differential Diagnosis of Azoospermia with Proteomic Biomarkers ECM1 and TEX101 Quantified in Seminal Plasma

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Science Translational Medicine  20 Nov 2013:
Vol. 5, Issue 212, pp. 212ra160
DOI: 10.1126/scitranslmed.3006260

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To Retrieve, or Not to Retrieve, May No Longer Be the Question

Infertility is a very common medical problem, and male partners are responsible for about half the cases. However, male infertility is not a homogeneous disorder, but a collection of diagnoses with different causes and different potential treatments. One type of male infertility, obstructive azoospermia (OA), is caused by physical obstruction to the movement of sperm, whereas the sperm cells themselves are normal. Nonobstructive azoospermia (NOA), on the other hand, is caused by abnormalities in the production of sperm. Hypospermatogenesis (HS) and maturation arrest (MA) are types of NOA where some sperm cells are still present, but their number is decreased or they do not fully mature. Meanwhile, in Sertoli cell–only syndrome (SCO), the patients do not make sperm cells at all.

Although all of these diagnoses lead to an infertile phenotype in unaided reproduction, they differ as to whether the patient’s testes contain any fertile sperm. In cases of OA, and often even HS and MA, sperm can be retrieved from the testis and used for assisted reproduction. In SCO, however, no sperm cells are available for retrieval. With current technology, the only way to distinguish between these scenarios is to search for sperm within the testis, which often requires a full surgical procedure. Now, Drabovich and coauthors have identified two protein biomarkers in seminal plasma that should help facilitate the differential diagnosis of azoospermia. Using these markers, physicians may be able to distinguish patients with OA and NOA, and SCO versus other types of NOA, and thus avoid subjecting patients with SCO to ineffective surgical interventions.

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