Step Closer to MRI Biomarker for Male Infertility

Sperm stained for analysis. Image source: Wikimedia Commons.

Urologist Joseph Alukal, MD, and magnetic resonance imaging scientist Pippa Storey, PhD, along with co-authors, report in a new study published in Investigative Radiology that they used a magnetic resonance spectroscopy (MRS) method to distinguish between men with a kind of infertility called non-obstructive azoospermia and fertile men.

Despite not having sperm in the semen, some men with non-obstructive azoospermia do have sperm in the testes. If present, such sperm can be retrieved surgically by testicular sperm extraction (TESE) or by microdissection testicular sperm extraction (micro-TESE), thus giving some men with infertility the opportunity to father children via artificial insemination methods.

However, surgical intervention is intricate and outcomes uncertain. Testes have to be opened for the surgeon to see the testicular tubules that are only about 200 micrometers (eight thousandths of an inch) in diameter. The surgeon then tries to identify the tubules that may contain sperm. Authors note that “in 40-60% of patients undergoing micro-TESE, no sperm is found.” Moreover, surgical intervention may cause adverse effects, such as scarring, devascularization, and lowered levels of serum testosterone.

But if there were a non-invasive biomarker for presence or absence of sperm in men with non-obstructive azoospermia, many patients could be spared what is a de-facto exploratory testicular surgery as well as its cost and possible complications.

In this study, the authors take a step toward such a biomarker by demonstrating that MRS at 3 Tesla—a modality widely available clinically—can distinguish between men with infertility and controls. The next question authors plan to investigate is whether MRS can also distinguish between men with non-obstructive azoospermia who have sperm in the testes and those who do not. If yes, MRS methods may help doctors reduce the number of unnecessary interventions and increase odds of good outcomes for patients.

Related article:
Storey P1, Gonen O, Rosenkrantz AB, Khurana KK, Zhao T, Bhatta R, Alukal JP. Quantitative Proton Spectroscopy of the Testes at 3 T: Toward a Noninvasive Biomarker of Spermatogenesis. Invest Radiol. 2017 Sep 5. doi: 10.1097/RLI.0000000000000414


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