Does an atrophied testicle still produce sperm?

Sperm Production in Atrophied Testicles

An atrophied testicle typically has significantly reduced or absent sperm production, especially when associated with elevated FSH levels above 7.6 IU/L, which indicates spermatogenic failure. 1

Testicular Atrophy and Spermatogenesis

Testicular atrophy is characterized by decreased testicular volume and compromised function, which directly impacts sperm production:

• Testicular atrophy is strongly associated with spermatogenic failure (non-obstructive azoospermia) when accompanied by elevated FSH levels above 7.6 IU/L 1
• Sperm count and motility decrease in accordance with declining testicular volume, with the lowest sperm parameters found in patients with bilateral testicular atrophy 2
• Testicular volume is considered a reliable indicator of testicular function, with smaller volume correlating to poorer spermatogenesis 2

Clinical Assessment of Atrophied Testicles

When evaluating an atrophied testicle for potential sperm production:

• Physical examination should assess testicular size, consistency, and presence of any associated abnormalities such as varicoceles or epididymal abnormalities 1
• Scrotal ultrasound can provide accurate testicular volume assessment, especially in cases where physical examination is difficult (e.g., large hydrocele, thickened scrotal skin) 1
• Hormonal evaluation, particularly FSH levels, helps determine the likelihood of sperm production - elevated FSH (>7.6 IU/L) with testicular atrophy strongly suggests spermatogenic failure 1

Causes and Implications of Testicular Atrophy

Various factors can lead to testicular atrophy, affecting sperm production differently:

• Primary causes include ischemic events (testicular torsion), cryptorchidism, and genetic abnormalities 3
• Secondary causes include surgical complications (e.g., from inguinal hernioplasty due to thrombosis of spermatic cord veins) 4
• Varicoceles associated with ipsilateral testicular hypotrophy correlate with significantly lower total motile sperm counts compared to those without hypotrophy (80 ± 5.2 versus 126 ± 7.8 × 10^6 sperm) 5

Genetic Considerations in Testicular Atrophy

Genetic testing should be considered in cases of testicular atrophy with severe oligospermia or azoospermia:

• Karyotype testing is strongly recommended for males with severe oligozoospermia (<5 × 10^6/ml) or non-obstructive azoospermia, as chromosomal abnormalities are more common in this population 1
• Y-chromosome microdeletion testing should be offered to men with testicular atrophy and severe oligozoospermia or non-obstructive azoospermia 1
• Klinefelter syndrome (47,XXY) is the most common chromosomal abnormality associated with testicular atrophy and spermatogenic failure 1

Fertility Preservation Options

For men with atrophied testicles who desire fertility:

• Microsurgical testicular sperm extraction (micro-TESE) may be considered for men with non-obstructive azoospermia to search for areas of preserved spermatogenesis 1
• Micro-TESE has been shown to be 1.5 times more successful than non-microsurgical testis sperm extraction in men with non-obstructive azoospermia 1
• Early repair of conditions causing testicular damage (such as varicoceles) may help preserve remaining hormonal function and fertility potential 6

Long-term Monitoring

Men with testicular atrophy require monitoring for:

• Potential development of testicular cancer, as men with testicular atrophy may have a higher risk of malignancy 1
• Hormonal deficiencies that may develop or worsen over time 3
• Changes in the contralateral testicle, which may also be affected even in unilateral conditions 1