In the infertile male patients, with azoospermia or severe oligospermia (less than 5 million per mililiter), the primary endocrine defect shold be considered. Specific hormonal therapy is often successful when an endocrinopathy is discovered.
The spermatogeneses, which occur in seminiferous tubule by germ cell are closely related with the hypothalamicpituitary - gonadal axis. The axis is a closed-loop feedback control mechanism regulating normal reproductive function.
The serum level of follicle-stimulating hormone(FSH) is determined and if indicated, values for luteinizing hormone (LH), testosterone (T), estrogen and prolactin are obtained. The gonadotropins, FSH and LH, give useful information about the status of various cell types in the tests. Testosterone is necessary in high intratesticular concentrations for spermatogenesis to proceed normally. FSH reflects activity in the seminiferous tubules. LH regulates activity in Leydig cell function, thus serum LH is an indirect measurement of Leydig cell status. Prolactin levels should be obtained if the patient complains concomitantly of impotence.
In conclusion, it can be summarized as follows; normal T, FSH and LH. - nonendocrine, decreased T, elevated LH and FSH. - primary testicular failure, decreased T, LH and FSH, - secondary testicular failure, normal T and LH, elevated FSH. - isolated germ cell failure, elevated T and LH, normal FSH. - androgen resistance syndrome.
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