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Had vericocele operation, testicular biopsy showed hypospermatogenesis with Leydig's cell hyperplasia. Treatment?

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Infertility Specialist
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Sir,This is XXXXXXX from VIJAYAWADA, A.P,INDIA.I am suffering with male infertilty problem.5years before i gone for vericosil operation.But my problem not yet solve.and then go for testicular baiapsy.In report i am suffering of HYPOSPERMATOGENISIS WITH LEYDIG CELL HYPER PLASIA.Please give me the suggeston and treatment where i go near my town.

Thanking you sir
Posted Mon, 30 Apr 2012 in Infertility Problem
Answered by Dr. Mahesh Koregol 1 hour later

Thanks for your query.

I understand the pain and agony you are facing due to male infertility. Let me help you as much as I can.

Spermatogenic activity requires sufficient hormone called testosterone. Testosterone is produced by the Leydig cells under the influence of luteinizing hormone (LH) secreted from pituitary gland at the base of human brain.

Testicular Leydig's cell hyperplasia is a rare benign condition that is characterized by small, multifocal, and frequently bilateral, testicular nodules. Primary leydig cell hyperplasia is seen in children. However, in the secondary form of leydig cell hyperplasia, which more often occurs in adults, the nodules of Leydig's cell hyperplasia are typically not palpable, and the diagnosis of Leydig's cell hyperplasia is often made with imaging studies or by testicular biopsy as done in your case.
Leydig's cell hyperplasia is due to a faulty hypothalamic—pituitary—testicular axis with resultant chronic Leydig's cell stimulation.

Hence following would be my advice for you:

1) As far as infertility part is concerned, you have to go for Invitro fertilization techniques (IVF) and Intracytoplasmic sperm injection (ICSI) with your sperm. AS you have hypospermatogenesis, this can be tried if you have any live sperm production in your testis.

2) If no mature sperms are present in your testis, you and your wife will have to be treated by accepting donor sperms and performing intrauterine insemination (IUI) to your wife.

3) Please see an oncologist to rule out testicular cancer. It is a serious conditions and hence to be ruled out. Oncologist may perform an MRI (Magnetic Resonant Imaging) scan to rule out testicular cancer.

4) If cancer is ruled out, testosterone replacement can be tried by synthetic preparations. The success of this is not significant; but can be attempted.

Unfortunately, your varicocele surgery was not much of help.

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I hope I answered your query. Please accept my answer if no more queries.

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