腮腺炎感染後不孕男性患者的臨床取精成果
陳人傑1、陳威任1,2、黃志賢1,2
台北榮民總醫院 泌尿部1; 國立陽明大學醫學院 泌尿學科 書田泌尿科學研究中心2
Sperm retrieval outcome of infertile men with previous episode of mumps orchitis.
Jen-Chieh Chen1, Wei-Jen Chen1,2, Williams J. Huang1,2
Department of Urology, Taipei Veterans General Hospital1;
Department of Urology, School of Medicine and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan2
Purpose: Mumps virus may attack testicular tissue, leading infiltration of lymphocytes in testes, with subsequent necrosis of the seminiferous tubules and atrophy of the testes. Although the incidence of mumps orchitis has dramatically declined since the introduction of the childhood measles mumps and rubella (MMR) vaccination program, vaccine effectiveness may decline over time, therefore people who previously had MMR vaccination may still get mumps. Mumps related infertility still remains an important issue in andrology.
Materials and Methods: We reviewed our patient database from March 2009 to September 2018. Total 11 male infertility patients with previous mumps orchitis history were enrolled. The semen analysis, testicular volume, hormone profile, and sperm retrieval outcome were retrospectively investigated.
Result: The mean age was 37 years old (range 29-50). Although one patient had barren marriage for 4 years, his semen analysis was in normal range, possibly due to only unilateral testis was affected by mumps, since his left testis was of normal size but right testis was atrophic. One patient was presented with oligoasthenoteratozoospermia and nine were presented with azoospermia. All azoospermic patients received microdissection testicular sperm extraction (mTESE). Sperm was retrieved successfully from 2 patients. Seven patients who failed sperm retrieval, pathology revealed Sertoli cell only in six patients, and tubular hyalinization in one patient. The average age of mumps infection was older in patients who had sperm retrieved. (17.3 vs. 14.7). It seemed that the average testis volume was larger in patients who had sperm retrieved. (Right testis: 13 c.c. vs. 11 c.c.; Left testis: 17 c.c. vs. 9 c.c.). The FSH and testosterone level seemed no difference between groups (FSH: 25 mIU/ml vs. 23 mIU/ml; Testosterone: 4 ng/ml vs. 3.1 ng/ml).
Conclusions: Mumps orchitis may cause persistent and irreversible damage to spermatogenesis. Patients with larger testis size, older age when infected by mumps, may have higher possibility of sperm retrieval, possibly due to the intratesticular structures were not totally damage. Our sperm retrieval rate was lower than it reported in previous literature, possibly owning to retrospective study with recall bias.