A 34-year-old man is investigated for azoospermia. His FSH is 32 IU/L (markedly elevated) and testicular volume is 6 mL bilaterally (normal >15 mL). LH is also elevated and testosterone is low. Testicular biopsy shows complete absence of germ cells with only Sertoli cells lining the seminiferous tubules (Sertoli-cell-only syndrome). The prognosis for fertility with these findings is:

• A Normal fertility after hormonal stimulation with gonadotropins
• B Sperm retrieval and ICSI usually successful with surgical testicular sperm extraction (TESE)
• C Varicocele repair will restore spermatogenesis
• D Donor sperm is the only option as no sperm production is possible ✓

Explanation

Sertoli-cell-only syndrome (Del Castillo syndrome) is a non-obstructive azoospermia characterised by complete absence of spermatogenic cells, with only Sertoli cells present in the seminiferous tubules. When this pattern is complete and uniform on biopsy, no sperm can be produced, and even surgical sperm retrieval (TESE/microTESE) is futile. Donor sperm insemination or adoption are the only options for fatherhood. This contrasts with focal Sertoli-cell-only pattern where isolated foci of spermatogenesis may allow microTESE success.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.