The Only Treatment Known to Take Sperm Count From 0 to 20 Million Within 6 Months in Sertoli Cell Only Syndrome.
In the last decade , we have seen few cases of Sertoli cell only syndrome in our practice. Though such cases are usually rare and Infertility specialist recommended them for IVF, we have helped few males with Sertoli cell only syndrome achieve a natural conception in the past. The treatment commonly involves a customised genetic Homeopathic treatment and nutritional supplements in the exact quantity as required for the successful maturation of sperms.
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Sertoli cell only syndrome (SCO syndrome) is a condition of the testes that causes infertility in males due to having only Sertoli cells (cells that nurture immature sperm) lining the seminiferous tubules (tubes inside the testicles where sperm develop). Men typically learn they are affected between ages 20-40 when being evaluated for infertility and are found to have no sperm production (azoospermia). The diagnosis is made based on testicular biopsy findings. Other signs and symptoms are rare, but are secondary to the underlying condition causing Sertoli cell-only syndrome . Most cases are idiopathic (of unknown cause), but causes may include deletions in the azoospermia factor (AZF) region of the Y chromosome, or Y-chromosome microdeletions (referred to as Y chromosome infertility); Klinefelter syndrome; exposure to chemicals and toxins; history of radiation therapy; and history of severe trauma. There is not currently a known effective treatment for the condition.When no germ cells are visible in any seminiferous tubules it is considered Sertoli cell-only syndrome type I; if germ cells are present in a minority of tubules is it considered Sertoli cell-only syndrome type II.
Primary testicular failure occurs in approximately 1% of all men, and is present in 10% of those obtaining medical consultation for infertility. Sertoli cell-only syndrome (SCOS), also known as germinal cell aplasia, is not an uncommon finding in testicular biopsies that are performed in these patients. The salient histopathologic feature of SCOS is the absence of germ cells. The seminiferous tubules are lined by Sertoli cells which may resemble immature (prepubertal) or mature Sertoli cells, or have other changes which may correlate with specific etiologies and clinical findings. Many of these patients are karyotypically normal and have normal secondary male sexual characteristics, yet are infertile and azoospermic (having no detectable sperm counts), or at most have very low sperm counts.
According to the studies, five morphologic variants of Sertoli cell-only syndrome are recognized, which include immature, dysgenetic, mature (adult-type), involuting, and dedifferentiated. Recognition of these variants is important to assess the etiology of germinal cell aplasia in a given patient. In addition, in a small number of the patients with the mature and dysgenetic variants, focal spermatogenesis may be observed. The dysgenetic, mature, and involuting variants of Sertoli cell-only syndrome are more commonly encountered than the immature and dedifferentiated variants. The three former variants are associated with elevated follicle stimulating hormone, normal or elevated luteinizing hormone, and normal testosterone levels. This constellation of findings, taken together with Sertoli cell-only histology, infertility, and azoospermia, was formerly known as the del Castillo syndrome.
The immature variant is caused by a primary deficiency of FSH and LH production that begins in childhood and, as a result, maturation and renewal of germ cells does not occur. Diameters of the seminiferous tubule are generally decreased in all forms of SCOS, but this is most prominent in the immature variant, where tubular diameter may be less than 80. Sertoli cells exhibit pseudostratification and are rounded or oval and have dark chromatin. Tubular lumens are small or absent.
In the mature variant, the seminiferous tubules are lined by mature-appearing columnar Sertoli cells, some which have roughly triangular (so-called tripartite) nuclei and/or vacuolated cytoplasm. Seminiferous tubular diameters are smaller than in normal adult testes, but larger than in immature Sertoli cell-only syndrome ; tubular lumens are open. The putative pathogenesis is failure of migration of germ cells from the primitive yolk sac to the gonadal ridge. In spite of this, the Sertoli cells, under normal hormonal regulation, develop relatively normally. Some patients with mature SCOS have a history of viral orchitis; many cases are idiopathic.
The dysgenetic variant is characterized by Sertoli cells with some degree of maturation, primarily of the cytoplasm. The pseudostratified nuclei do not assume the tripartite configuration of mature Sertoli cells, but have irregular outlines and sometimes have coarse chromatin granules. Sometimes an admixture of mature and immature-appearing Sertoli cells is observed, with variation between seminiferous tubules and even within tubules. Tubular lumens are generally inconspicuous. Dysgenetic morphology has been associated with abnormalities of the Y chromosome and cryptorchid testes.
The involuting variant of SCOS is characterized by atrophic changes of the Sertoli cells; the nuclei are lobulated and have irregular outlines. Tubular lumens are open and basement membranes are generally thickened. The interstitium may be fibrotic. Presumably the cause of the atrophy in Sertoli cells is also the cause of the loss of germinal cells; Leydig cells are variably involved. Etiologies include irradiation, cancer chemotherapy, and cyclophosphamide. Similar findings are observed in the normal aging process, and therefore some cases may represent premature or accelerated aging.
In the dedifferentiated variant of Sertoli cell-only syndrome , immature-appearing Sertoli cells are present in otherwise normal seminiferous tubules. Similar to the immature variant, the Sertoli cells have rounded nuclei and exhibit pseudostratification. In contrast, however, the tubules are larger and have open lumens. Etiologies of dedifferentiated SCOS include hormonal therapy for prostate cancer, cisplatin, and estrogen given to transsexual patients. Fibrosis and thickening of the basement membrane are not features of this variant.
Anniballo et al.divided Sertoli cell-only syndrome into two categories: pure (congenital) and mixed (secondary). The pure form in their conceptualization is caused by failure of migration of germ cells. The mixed form is related to postnatal damage to previously healthly testicular tissue. These authors state that retrieving germ cells in cases of pure Sertoli cell-only syndrome is impossible. Therefore, these cases should be identified in order to spare unnecessary medical expenses and inconvenience to patients. Positive immunostaining of seminiferous tubules for vimentin and negative staining for cytokeratin was associated with pure Sertoli cell-only syndrome. In mixed SCOS, there are features that correlate with the focal presence of germ cells that may be translated into increased likelihood of successful sperm retrieval are present. These features include positive staining for lipids in Sertoli cell cytoplasm that indicates of reabsorption of germ cells and presence of telomerase activity. The combination of increased inhibin and normal serum FSH levels is also an indication of the presence of spermatids.
Treatment of Sertoli cell-only syndrome
A customised Homeopathy treatment at Welling Clinic has proven to act at the deepest level, stimulating the germ cells and thus helping in the treatment of Sertoli cell-only syndrome. A treatment protocol devised according to your specific needs and combining it with our research in nutritional science can help your wife to conceive naturally at the earliest.