Clinical And Microbial Ecology Research Of Azoospermia

Aim:To analysis and compare the difference of clinical indexes between obstructive azoospermia(OA)and non-obstructive azoospermia(NOA).To evaluate the efficacy of microscopic surgery for obstructive azoospermia.To demonstrate whether the seminal microbiome is associated with azoospermia.Patients and Methods:From July 2015 to February 2017,60 azoospermia patients from the First Affiliated Hospital of Zhejiang University and Hangzhou Renyu Hospital were enrolled.Divided these azoospermia patients into two groups based on the outcomes of epididymis and testis biopsy.One was obstructive azoospermia group(A group,N=30),the other one was non-obstructive azoospermia group(B group,N=30).Compared the difference of clinical indexes between these two groups.Among these 30 OA patients,20 patients accepted the treatment of microscopic surgery.We followed up these patients for 1 to 20 months for the patency rate,routine semen parameters,and pregnancy outcomes.Among these 60 azoospemia patients,semen of 27 patients were collected.Besides,semen of 24 healthy volunteers were collected.The seminal microbial community was investigated by Hiseq sequencing of the 16S ribosomal V3-4 region.Results:The causes of these two groups were different.The left side and right side testicular volumes of A group were significantly larger than B groups'(P<0.01).The FSH and LH levels of A group were significantly lower than B groups'(P<0.01).However,the testosterone level of A group was significantly higher than B group ' s(P<0.01).The seminal fructose and neutral alpha-glucosidase levels of A group were significantly lower than B groups'(P<0.01).The successful rates of bilateral vasoepididymostomy,unilateral vasoepididymostomy,bilateral vasovasostomy and unilateral vasovasotomy were 46.2%(6/13)?0%(0/1)?100%(2/2)?0%(0/1),respectively.The average sperm concentration of patients after bilateral vasoepididymostomy was(25.6 ± 22.8)X 106/ml,the average sperm motility rate was(12.9%± 16.1%),the mean rate of progressively motile sperm was(8.1%± 13.7%).Lower diversity and a distinct change in the seminal microbiome were found in patients with azoospermia.Compared with healthy people,some key functional bacteria existed in the semen of azoospermia patients and could be used as biomarkers.Conclusions:The causes of obstructive azoospermia and non-obstructive azoospermia are different.Compare with NOA patients,OA patients have larger testicular volumes.The FSH,LH,testosterone and PRL levels of OA patients are normal.NOA patients can be divided into high gonadotrophin hypogonadism and low gonadotropin hypogonadism.The former has higher levels of FSH and LH when the latter has lower levels of FSH and LH.Both of them have lower levels of testosterone.Microscopic surgery has treatment effect on epididymal obstruction and vas deferens obstruction.And bilateral anastomosis may have higher patency rate than unilateral anastomosis.Seminal dysbiosis is found in azoospermia patients,which could be a novel mechanism for azoospermia.