Congenital anomalies of the mesonephric duct and fertility

Agenesia of deferential duct and the others congenital malformations of mesonephronical duct are often encountering condition in andrological practice. This study presents the possibilities of reproductive medicine to restore the male fertility and concentrates on biological and clinical aspects of malformations of mesonephronic duct like factors for excretory male infertility. The investigations including 104 patients (mean age 30.25+/-1.91 years old) with congenital anomalies of mesonephronical duct with: Agenesia of mesonephronical derivates - case with unilateral agenesia of the deferent duct, kidney and left urether (n=1); Dysgenesia of the epididymis (n=5); Cysts of the epididymis (n=47); Agenesia of the deferential duct (n=48); Aplasia of the eja-culatorial duct (n=3). The following methods were used: open testicular biopsy by Vilar; objective findings in situ operation; bilateral epididymo - and deferentovesiculography; morphological specimens of the testicular and epididymal tissues; enzymohistochemical analysis of testicular specimens; the ejaculates and morphological analysis of spermatozoa were assessed for quality parameters by the standard protocol; enzymocytological research of spermatozoa in seminal fluid; biochemical analysis of seminal fluid fructose and citric acid concentrations; radioimmunoassay for measurements of blood FSH and testosterone concentration.

Most often observed localization of the malformations of mesonephronic canal is bilateral at 54.81%. The testicular specimens proved preserved testicular architecture and spermatogenesis, and the epididymal slides showed dilatation of the epididymal tubules, which were overfilled with a lot of spermatozoa. The strongest expression of the enzymichistochemical NADH-TR reactions is in the Sertoli cells. We observed spermatozoa with disrup-ted configuration among which the abnormalities in sperm head and acrosome were predominated. The biochemical analysis of seminal fluid proves normal citric acid and low or lack of fructose concentration in seminal fluid. There were no breaches in endocrine regulation of the reproductive process. Patients with congenital anomalies of mesonephronic canal have preserving fertility in 31.73%. There are morpho-functional disorders of the testes, epididymis and seminal ducts in 68.27%.

There are normal spermatogenesis but definite sterility. These results necessitate an application of plastic reconstructive operation for recovery of fertilizing ability of the patients, or their involvement in ICSI programme.