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Sertoli Cell Only Syndrome
Some men with this diagnosis may still have small pockets of sperm cell production in their testicular tissue.
It is not unusual for men with azoospermia to have high follicle-stimulating hormone (FSH) levels. A high FSH level is a sign of damage in the testicle to the sperm producing cells. Sertoli Cell Only Syndrome, also known as germinal cell aplasia, is the most common diagnosis for men having a high level of the hormone and no sperm found in their semen. Many of these patients are karyotypically normal and have normal virilization. Their testes are of normal consistency but slightly smaller in size. Upon testicular biopsy there will be complete absence of germinal elements.
Sertoli Cells are a type of "nurse" cell inside the sperm-producing tubules. They nurture the developing sperm cells until they are fully formed and ready to be released to travel to the epididymis and beyond. As the name of the syndrome implies, the tubules contain only Sertoli cells and no parent spermatogonia cells or developing sperm. The Leydig cells, outside the tubules, produce normal amounts of testosterone, keeping LH levels normal. Without sperm formation, however, there is no feedback mechanism to tell the pituitary to decrease the amount of FSH it produces. Therefore, the levels of FSH are usually significantly elevated because the pituitary keeps striving to signal the testes to make sperm without the needed cells. The high levels of the hormone are a healthy response to the lack proper function of the testes.
Some men with this diagnosis may still have small pockets of sperm cell production in their testicular tissue. If these sperm cells can be found and retrieved, they can be used for IVF-ICSI. The only way to know if any sperm cells exist in the testicles is to surgically search for them. The FSH level is not a reliable indicator of sperm production.