Sexual and hormonal function of patientswith non-obstructive azoospermia with thechief complaint of infertility
Introduction: Over the past few years, increasedresearch has been done for aetiology and geneticbasis of azoospermia as well as the availability ofsurgical sperm retrieval methods andintracytoplasmic sperm injection (ICSI) for thetreatment of the resulting infertility. But the qualityof general life and the loss of sexual function havebeen evaluated. Sexual function has variousaspects such as penile erection, seminalejaculation, libido and frequency of sexualintercourse that may be involved alone or incombination in any patient. In this study, weevaluated sexual function of non obstructiveazoospermic patients with chief complaint ofinfertility besides clinical and hormonalpresentation of these patients.Materials and Methods: Between October 2004and November 2006, a total of 279 patients withinfertility due to non-obstructive azoospermia werereferred to Avesina Infertility clinic, Tehran, Iran.Before any diagnostic and therapeutic efforts,sexual function of these patients was evaluated bythe questionaire enriched with libido, penileerection, seminal ejaculation, interval untilejaculation, orgasm and frequency of sexualintercourse. Physical examination was carried outto determine androgen deficiency signs, semensamples were analyzed according to the currentWHO laboratory manual. Hormonal analysisincluded serum luteinzing hormone (LH), folliclestimualation hormone (FSH) and prolactin (PRL)Concentrations were measured by immunoradiometric(LRMA). Serum testosterone wasmeasured by radioimmunoassay (RIA).Conventional testicular biopsy was performed onboth testes by standard procedure under localanesthesia.Results: 279 non-obstructive azoospermic patientswere studied. In terms of sexual desire, 90% werenormal while 10% had slightly decreased levels ofsexual desire. Regarding erectile function, 80%were normal with the ability to engage in normalintercourse. Only 20% had decreased erectionupon vaginal insertion. With regards to ejaculation,75% had a normal semen volume whilst 25% had adecreased semen volume. The interval was untilejaculation was normal in 42.5% and verypremature or very late in 10%. Orgasm was normalin 80%, slightly decreased in 15% and significantlydecreased in 5%. 54.8% of patients had smalltesticles. 125 (44.8%), 139 (49.8%) and 15 (5.3%)of patients were normogonadotropic,hypergonadotropic and hypogonadotropic,respectively. Mean values of FSH, LH, andtestosterone and PRL were 24.5±25.4 IU/L, 9±7.2IU/L, 6.1±4.4 ng /ml and 284±224. 42 (15%) ofpatients had hypospermatogenesis with maturesperms in testis biopsy. Histological appearanceshowed testicular atrophy in 21.8%, maturationarrest in 22.2%, sertoli cell syndrome in 40.8% andhyperplasia of leydig cells in 11.8%.Conclusion: Sexual dysfunction is common innon-obstructive azoospermia that affects followinginfertility treatment. In azoospermia sexualdysfunction is not taken attention due todominancy of infertility in these patients. Specialattention to these problems will improve quality oflife and effectiveness of infertility treatment.