Deletion or underexpression of the Y-chromosome genes CDY2 and HSFY is associated with maturation arrest in American men with nonobstructive azoospermia

Maturation arrest （MA） refers to failure of germ cell development leading to clinical nonobstructive azoospermia. Although the azoospermic factor （AZF） region of the human Y chromosome is clearly implicated in some cases, thus far very little is known about which individual Y-chromosome genes are important for complete male germ cell development. We sought to identify single genes on the Y chromosome that may be implicated in the pathogenesis of nonobstructive azoospermia associated with MA in the American population. Genotype-phenotype analysis of 132 men with Y-chromosome microdeletions was performed. Protein-coding genes associated with MA were identified by visual analysis of a genotype-phenotype map. Genes associated with MA were selected as those genes within a segment of the Y chromosome that, when completely or partially deleted, were always associated with MA and absence of retrievable testicular sperm. Expression of each identified gene transcript was then measured with quantitative RT-PCR in testicular tissue from separate cohorts of patients with idiopathic MA and obstructive azoospermia. Ten candidate genes for association with MA were identified within an 8.4-Mb segment of the Y chromosome overlapping the AZFb region. CDY2and HSFYwere the only identified genes for which differences in expression were observed between the MA and obstructive azoospermia cohorts. Men with obstructive azoospermia had 12-fold higher relative expression of CDY2transcript （1.33__.0.40 vs. 0.11＋_0.04; P=O.O003） and 16-fold higher expression of HSFYtranscript （0.78__.0.32 vs. 0.05_0.02; P=O.O005） compared to men with MA. CDY2 and HSFYwere also underexpressed in patients with Sertoli cell only syndrome. These data indicate that CDY2and HSFYare located within a segment of the Y chromosome that is important for sperm maturation, and are underexpressed in testicular tissue derived from men with MA. These observations suggest that impairments in CDY2 or HSFYexpression could be implicated in the pathogenesis of MA.

Testicular volume is a noninvasive predictor of sperm retrieval failure in idiopathic nonobstructive azoospermia

We investigated the prognostic importance of noninvasive factors in predicting sperm retrieval failure in idiopathic nonobstructive azoospermia(iNOA).We studied 193 patients with nonobstructive azoospermia who underwent microsurgical testicular sperm extraction.The Chi-square test and Mann–Whitney U tests for clinical parameters and seminiferous tubule distribution were used for between-group comparisons.A logistic regression analysis was conducted to identify predictors of retrieval failure.Area under the receiver operating characteristic curve for each variable was evaluated,and the net clinical benefit was calculated using a clinical decision curve.Patients with iNOA had a lower sperm retrieval rate than those with known causes.Moreover,testicular volume was an independent factor affecting sperm extraction outcomes(odds ratio=0.79,P<0.05).The testicular volume cut-off value was 6.5 ml(area under the curve:0.694).The patients with iNOA were categorized into two groups on the basis of the distribution of seminiferous tubules observed.The sperm retrieval rate and testicular volume were significantly different between the groups with a uniform or heterogeneous tubule distribution.There was also a significant association between a uniform tubule distribution and testicular volume.In conclusion,a testicular volume of more than 6.5 ml effectively predicts microsurgical testicular sperm extraction failure due to a uniform tubule distribution in patients with iNOA.

基于PERMA模型的心理干预对非梗阻性无精子症患者心理健康状况幸福指数及积极心理品质的影响

目的探讨基于PERMA模型的心理干预对非梗阻性无精子症患者心理健康状况、幸福指数及积极心理品质的影响。方法将行穿刺取精的64例非梗阻性无精子症患者按数字表法随机分为研究组(34例)和对照组(30例)。对照组接受常规护理干预,研究组在对照组基础上接受基于PERMA模型的心理干预,干预6周,随访2周复诊。干预前后及随访2周采用一般健康问卷、PERMA幸福指数量表以及积极心理品质量表评定患者的健康状况、幸福感及积极心理品质,比较两组上述量表评分。结果干预后及随访2周研究组一般健康问卷总分及自我肯定、焦虑维度评分较干预前显著降低(P<0.05或0.01),且显著低于对照组(P<0.05或0.01)。干预后及随访2周,研究组PERMA幸福指数量表总分及积极情绪、投入、意义维度评分均较干预前显著升高(P<0.05或0.01),且显著高于对照组(P<0.05或0.01),但关系维度评分两组间及干预前后组内比较差异均无统计学意义(P>0.05)。干预后及随访2周,研究组积极心理品质量表总分及勇气、正义、自制、精神卓越维度评分均较干预前显著升高(P<0.05或0.01),且显著高于对照组(P<0.05或0.01)。对照组上述量表评分干预前后及随访2周组内比较差异无统计学意义(P>0.05)。结论基于PERMA的心理干预能够显著提升非梗阻性无精子症患者的积极心理品质、幸福指数,改善其心理健康状况,优于常规护理干预。

Identification of risk genes in Chinese nonobstructive azoospermia patients based on whole-exome sequencing

Nonobstructive azoospermia(NOA)is a severe condition in infertile men,and increasing numbers of causative genes have been identified during the last few decades.Although certain causative genes can explain the presence of NOA in some patients,a proportion of NOA patients remain to be addressed.This study aimed to investigate potential high-risk genes associated with spermatogenesis in idiopathic NOA patients by whole-exome sequencing.Whole-exome sequencing was performed in 46 male patients diagnosed with NOA.First,screening was performed for 119 genes known to be related to male infertility.Next,further screening was performed to determine potential high-risk causative genes for NOA by comparisons with 68 healthy male controls.Finally,risk genes with high/specific expression in the testes were selected and their expression fluctuations during spermatogenesis were graphed.The frequency of cystic fibrosis transmembrane conductance regulator(CFTR)gene pathogenic variant carriers was higher in the NOA patients compared with the healthy controls.Potential risk genes that may be causes of NOA were identified,including seven genes that were highly/specifically expressed in the testes.Four risk genes previously reported to be involved in spermatogenesis(MutS homolog 5[MSH5],cilia-and flagella-associated protein 54[CFAP54],MAP7 domain containing 3[MAP7D3],and coiled-coil domain containing 33[CCDC33])and three novel risk genes(coiled-coil domain containing 168[CCDC168],chromosome 16 open reading frame 96[C16orf96],and serine protease 48[PRSS48])were identified to be highly or specifically expressed in the testes and significantly different in the 46 NOA patients compared with 68 healthy controls.This study on clinical NOA patients provides further evidence for the four previously reported risk genes.The present findings pave the way for further functional investigations and provide candidate risk genes for genetic diagnosis of NOA.

非梗阻性无精子症的遗传学病因及治疗研究进展

非梗阻性无精子症(NOA)病因复杂,是由多因素引起的具有高度遗传异质性和表型异质性的复杂疾病,其中遗传学病因包括染色体异常、Y染色体微缺失、基因突变以及表观遗传修饰等。目前尚缺乏统一有效的恢复生精功能的治疗策略。目前治疗方案主要有术前激素优化治疗、改变睾丸生精微环境、干细胞疗法等。本文对现存的NOA遗传学病因以及相关的治疗方法进行综述,以期对今后的临床治疗提供一定的指导意义。

Efficacy of stepwise mini-incision microdissection testicular sperm extraction for nonobstructive azoospermia with varied etiologies

Stepwise mini-incision microdissection testicular sperm extraction(mTESE)is a procedure that attempts to minimize testicular damage.However,the mini-incision approach may vary in patients with different etiologies.Here,we performed a retrospective analysis of 665 men with nonobstructive azoospermia(NOA)who underwent stepwise mini-incision mTESE(Group 1)and 365 men who underwent standard mTESE(Group 2).The results showed that the operation time(mean±standard deviation)for patients with successful sperm retrieval in Group1(64.0±26.6min)was significantly shorter than that in Group2(80.2±31.3min),with P<0.001.The total sperm retrieval rate(SRR)was 23.1%in our study,and there was no significant difference between Group 1 and Group 2(P>0.05),even when the etiologies of NOA were taken into consideration.The results of consecutive multivariate logistic regression analysis(odds ratio[0R]:0.57;95%confidence interval[Cl]:0.38-0.87;P=0.009)and receiver operating characteristic(ROC)analysis(area under the ROC curve[AUC]=O.628)showed that preoperative anti-Mullerian hormone(AMH)level in idiopathic NOA patients was a potential predictor for surgical outcomes after initial three small incisions made in the equatorial region without sperm examined under an operating microscope(Steps 2-4).In conclusion,stepwise mini-incision mTESE is a useful technique for NOA patients,with comparable SRR,less surgical invasiveness,and shorter operation time compared with the standard approach.Low AMH levels may predict successful sperm retrieval in idiopathic patients even after a failed initial mini-incision procedure.

Laboratory and Clinical Outcomes of Single Sperm Cryopreservation in Patients Underwent Micro-TESE

For men with severe oligozoospermia, sperm cryopreservation can preserve surgically obtained sperm. How to cryopreserve single sperm in men is still a hot topic in assisted reproduction technology. Aim to analyze the laboratory and pregnancy outcomes of single sperm cryopreservation group, we retrospectively selected 38 cycles underwent single sperm cryopreservation and thawing as the study group and 618 cycles underwent conventional sperm cryopreservation and thawing as the control group, which were performed in the reproductive medicine center of the Sixth Affiliated Hospital, Sun Yatsen University, from April 2014 to October 2023. All the sperm came from microdissection testicular sperm extraction (micro-TESE), and performed intracytoplasmic sperm injection (ICSI) for fertilization. Zygotes were cultured to Day 3 embryo, which were freshly transferred to female uterus. Surplus embryos were cultured to blastosphere and cryopreserved. There was no statistical difference in female/male age, female BMI, infertility duration and female basal sex hormone (FSH, LH E2, AMH), No. of oocytes retrieved per cycle, No. of ICSI oocytes per cycle and No. of embryos transferred per cycle between the two groups (P > 0.05). No significant difference was found in two-pronuclear oocyte fertilization rate (59.23% VS 58.84%), Day 3 available embryo rate (61.81% VS 63.55%), Day 3 good-quality embryo rate (45.73% VS 50.27%), blastocyst formation rate (47.83% VS 49.46%), the implantation rate (47.37% VS 52.16%), clinical pregnancy rate (36.84% VS 47.18%), miscarriage rate (14.29% VS 12.68%) and live birth rate (85.71% VS 81.70%) between two groups (P > 0.05). In conclusion, single-sperm cryopreservation was the optimal method to preserve sperm after micro-TESE. It can increase the utilization of each sperm and lead to clinical pregnancy.

血清抑制素B对非阻塞性无精子症睾丸精子存在的预测价值

目的:探讨血清抑制素B(INHB)对非阻塞性无精子症(NOA)患者睾丸精子存在与否的预测价值。方法:分别对40例NOA、20例阻塞性无精子症(OA)及10例正常生育男性以双抗体夹心ELISA法测定其血清INHB水平。并用化学发光法检测了上述研究对象的卵泡刺激素(FSH)水平。结果:NOA患者的血清FSH[(21.34±12.15)IU/L]明显高于OA组和正常生育男性组[(3.94±1.52)IU/L和(4.27±2.84 IU/L],而血清INHB水平[(53.15±58.74)ng/L]明显低于后两者[(162.49±78.38)ng/L和(228.49±110.68)ng/L]。正常生育男性与OA组患者的血清INHB水平差异无显著性(P>0.05)。NOA患者血清INHB水平与其睾丸精子抽吸(TESE)的结果有相关性(r=0.528,P<0.01)。TESE获得精子者血清INHB水平[(90.31±72.18)ng/L]显著高于TESE无精子者[(19.54±20.38)ng/L,P<0.01];而两者的血清FSH差异无显著性(P>0.05)。结论:血清INHB可作为预测TESE的参考指标。血清INHB的测定有望替代睾丸活检确定睾丸精子的存在与否。

XRCC1基因rs25487位点多态性与陕西回族男性人群非梗阻性无精症的相关性

目的探讨X线修复交叉互补(XRCC1)基因rs25487位点多态性在陕西回族非梗阻性无精症人群中的分布及其与非梗阻性无精症发病风险的关联。方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)。方法检测79例陕西回族非梗阻性无精症患者和82例陕西回族正常对照男性人群XRCC1基因rs25487位点的基因分型和等位基因频率,分析其与非梗阻性无精症发病的相关性。结果与GG基因型的个体相比,携带GA基因型的个体患非梗阻性无精症的风险是携带GG基因型个体的2.286倍;携带AA基因型的个体患非梗阻性无精症的风险是GG基因型个体的2.202倍;携带GA+AA基因型的个体患非梗阻性无精症的风险是GG基因型的2.271倍。与G等位基因相比,携带A等位基因的个体患非梗阻性无精症的风险是G基因的1.158倍。结论 XRCC1基因rs25487位点G→A与陕西回族人群非梗阻性无精症发病风险存在关联。

非梗阻性无精子症患者睾丸局部生精功能的超声造影评估

目的·探讨超声造影定位对引导非梗阻性无精子症(NOA)患者睾丸显微取精术的应用价值。方法·95例NOA患者行睾丸超声造影,分别选取造影浓聚区和稀疏区进行定位并量化分析。显微取精术分别在造影浓聚区、稀疏区以及常规区取精。比较各个区域的取精成功率。结果·95例患者共147个睾丸行显微取精术,浓聚区、稀疏区和常规区的取精成功率分别为66.3%(63/95)、32.6%(31/95)和47.3%(45/95),两两比较差异具有统计学意义(均P<0.05)。在取精阳性位点组(94个位点)和取精阴性位点组(200个位点)对比中,造影起始增强时间、达峰时间、峰值强度和曲线下面积间差异均具有统计学意义(均P<0.05)。3个病理组间取精成功率具有差异,成熟障碍组和唯支持细胞综合征组中浓聚区取精成功率高于常规区(均P<0.05)。结论·不同的病理类型具有不同的取精成功率,通过术前睾丸造影定位浓聚区引导显微取精术可提高成熟障碍和唯支持细胞综合征患者的取精成功率。

SPO11基因单核苷酸多态性与陕西回族人群非梗阻性无精症相关性研究

目的探讨SPO11基因单核苷酸多态性在陕西回族非梗阻性无精症人群中的分布及其与无精症发病风险的关联。方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法,分析40例陕西回族非梗阻性无精症患者和45例陕西回族正常对照男性SPO11基因SNP位点(rs28368082)的基因分型和等位基因频率,以及其与非梗阻性无精症发病的相关性。结果 SPO11基因SNP位点(rs28368082)的CC,CT两种基因型频率在病例和对照组中分布存在显著性差异(P=0.048),携带CT基因型的个体患非梗阻性无精症的风险是CC基因型的7.76倍(95%CI=0.89～66.58)。结论SPO11基因SNP位点(rs28368082)与陕西回族人群非梗阻性无精症发病风险存在关联,可能是陕西回族人群非梗阻性无精症的遗传易感基因之一。

显微镜下睾丸切开取精术在非梗阻性无精子症治疗中的应用

目的探究显微镜下睾丸切开取精术在非梗阻性无精子症(NOA)治疗中的应用。方法选择我院收治的84例NOA患者为研究对象,均经精液离心检查后确定精液中无精子并行显微镜下睾丸切开取精术,分析显微镜下睾丸切开取精术在NOA治疗中的应用效果。结果手术后,患者体内的黄体生成素(LH)及血清卵泡刺激素(FSH)水平显著高于手术前,总睾酮(TT)显著低于手术前(P<0.05)。手术后,患者的国际勃起功能指数-5(IIEF-5)评分显著低于手术前,汉密顿焦虑量表(HAMA)评分显著高于手术前(P<0.05)。结论显微镜下睾丸切开取精术对NOA患者术后性功能、性激素水平以及心理状况均有显著影响,临床治疗在行该术时应针对上述问题进行处理,尽可能降低该术对患者的影响。

精子发生障碍的遗传学研究进展

育龄人群中约15%的夫妻被不孕不育困扰,其中男方因素导致的不孕不育约占50%。男性不育通常由精子发生障碍导致,呈现为少、弱、畸形精子症,最严重的是无精子症。本文以精子发生障碍为主线,重点综述了非梗阻性无精子症和畸形精子症的遗传学病因研究。近年来,随着高通量芯片和测序技术的快速发展,无精子症和畸形精子症的遗传学因素得以深入的揭示与解析。围绕无精子症,全基因组关联研究与高通量测序研究揭示了一批非梗阻性无精子症的风险位点和致病基因;围绕畸形精子症,全外显子测序等研究鉴定了一系列致病基因,极大地丰富了精子鞭毛多发性形态异常等精子畸形的遗传学病因。大量致病基因的发现,促进了男性不育病理机制的阐明。全面而深入地了解精子发生障碍中的遗传因素,对男性不育的诊断、临床治疗和遗传咨询具有重要的意义。

不同病因非梗阻性无精子症患者睾丸显微取精获精率的初步研究

目的初步探讨不同病因非梗阻性无精子症患者睾丸显微取精的获精率。方法选取2018年1月至2019年5月山东大学生殖医学研究中心完成睾丸显微取精的67例非梗阻性无精子症患者进行回顾性分析。统计分析获精率与患者年龄、睾丸体积、生殖内分泌激素水平、不同病因的相关性。结果睾丸显微取精术总体获精率为40.30%(27/67),按照手术是否获取精子,分为未获精组(n=40)与获精组(n=27),两组患者在年龄、睾丸体积、生殖内分泌激素水平比较,差异无统计学意义(P>0.05);按照不同病因分为六组:获精率分别为腮腺炎合并睾丸炎后组100.00%(7/7)、隐睾下降固定术后组42.86%(3/7)、AZFc缺失组37.5%(3/8)、克氏综合征组36.36%(4/11)、特发性无精子症组30.30%(10/33)和低促性腺激素型性腺功能减退综合征组0%(0/1),不同病因之间整体比较,差异具有统计学意义(P<0.05),六组间,腮腺炎合并睾丸炎后组与特发性无精子症组之间比较,差异具有统计学意义(P=0.001),其余各组间比较,差异无统计学意义(P>0.05)。结论睾丸显微取精术是治疗非梗阻性无精子症的一种有效手段,获精率与年龄、睾丸体积、生殖内分泌激素水平无明显相关性,不同病因的非梗阻性无精子症之间,获精率存在显著差异,腮腺炎合并睾丸炎后的患者较特发性无精子症患者有更高的获精率。

Clinical management of infertile men with nonobstructive azoospermia

The clinical management of men with nonobstructive azoospermia （NOA） seeking fertility has been a challenge for andrologists, urologists, and reproductive medicine specialists alike. This review presents a personal perspective on the clinical management of NOA, including the lessons learned over 15 years dealing with this male infertility condition. A five-consecutive-step algorithm is proposed to manage such patients. First, a differential diagnosis of azoospermia is made to confirm/establish that NOA is due to spermatogenic failure. Second, genetic testing is carried out not only to detect the males in whom NOA is caused by microdeletions of the long arm of the Y chromosome, but also to counsel the affected patients about their chances of having success in sperm retrieval. Third, it is determined whether any intervention prior to a surgical retrieval attempt may be used to increase sperm production. Fourth, the most effective and efficient retrieval method is selected to search for testicular sperm. Lastly, state-of-art laboratory techniques are applied in the handling of retrieved gametes and cultivating the embryos resulting from sperm injections. A coordinated multidisciplinary effort is key to offer the best possible chance of achieving a biological offspring to males with NOA.

Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia： a meta-analysis

We performed this meta-analysis to evaluate the predictive value of different parameters in the sperm retrieval rate （SRR） of microdissection testicular sperm extraction （TESE） in patients with nonobstructive azoospermia （NOA）. All relevant studies were searched in PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO. We chose three parameters to perform the meta-analysis： follicle-stimulating hormone （FSH）, testicular volume, and testicular histopathological findings which included three patterns： hypospermatogenesis （HS）, maturation arrest （MA）, and Sertoli-cell-only syndrome （SCOS）. If there was a threshold effect, only the area under the summary receiver operating characteristic curve （AUSROC） was calculated. Otherwise, the pooled sensitivity, specificity, positive likelihood ratio （PLR）, negative likelihood ratio （NLR）, and the diagnostic odds ratio （DOR） were also calculated. Twenty-one articles were included in our study finally. There was a threshold effect among studies investigating FSH and SCOS. The AUSROCs of FSH, testicular volume, HS, MA, and SCOS were 0.6119, 0.6389, 0.6758, 0.5535, and 0.2763, respectively. The DORs of testicular volume, HS, and MA were 1.98, 16.49, and 1.26, respectively. The sensitivities of them were 0.80, 0.30, and 0.27, while the specificities of them were 0.35, 0.98, and 0.76, respectively. The PLRs of them were 1.49, 10.63, and 1.15, respectively. And NLRs were 0.73, 0.72, and 0.95, respectively. All the investigated factors in our study had limited predictive value. However, the histopathological findings were helpful to some extent. Most patients with HS could get sperm by microdissection TESE.

Follicle-stimulating hormone as a predictor for sperm retrieval rate in patients with nonobstructive azoospermia, a systematic review and meta-analysis

Noninvasive parameters for predicating sperm retrieval rate （SRR） are desirables. Follicle-stimulating hormone （FSH） has been an important predictor since the first years of testicular sperm extraction. Recent studies showed continuous interests in FSH, with both pros and cons. Thus, we conducted a meta-analysis to evaluate the diagnostic value of FSH as a predictor for patients with nonobstructive azoospermia （NOA） taking testicular sperm retrieval. Eligible diagnosis tests were identified from electronic databases （Cochrane Central Register of Controlled Trials, Medline, and EMBASE） without language restrictions. The database search, quality assessment, and data extraction were performed independently by two reviewers. The reference standard was the sperm retrieval result. Diagnostic value of FSH were explored by area under receiver operation characteristics （ROC） curve using Review Manager, version 5.1.0 （Cochrane Collaboration, Oxford, UK） and Meta-DiSc, version 1.4. Meta regression will be done if there is heterogeneity. Then, we find 11 tests including a total of 1350 patients met the inclusion criteria. Our pooled analysis showed that the area under ROC curve of FSH was 0.72 ~ 0.04. Meta regression analyses showed that region and average age have an influence on the diagnostic value. FSH showed more diagnostic value with patients in East Asia and with younger patients. We concluded that FSH had moderate value in independently predicating SRR in men with NOA （area under curve 〉0.7）. More detailed diagnosis tests should be anticipated in the future to confirm the diagnostic value of other noninvasive parameters.

Y-chromosome microdeletions in nonobstructive azoospermia and severe oligozoospermia

The aim of the present work was to present the outcomes of the patients with Y-chromosome microdeletions treated by intracytoplasmic sperm injection （ICSI）, either using fresh （TESE） or frozen-thawed （TESE-C） testicular sperm and ejaculated sperm （EJAC）. The originality of this work resides in the comparisons between the different types of Y-microdeletions （AZFa, AZFb, and AZFc） and treatments, with detailed demographic, stimulation, embryological, clinical, and newborn （NB） outcomes. Of 125 patients with Y-microdeletions, 33 patients presented severe oligozoospermia （18 performed ICSI with ejaculated sperm） and 92 secretory azoospermia （65 went for TESE with 40 having successful sperm retrieval and performed ICSI）. There were 51 TESE treatment cycles and 43 TESE-C treatment cycles, with a birth of 19 NB （2 in AZFa/TESE-C, 12 in AZFc/TESE, and 5 in AZFc/TESE-C）. Of the 29 EJAC cycles, there was a birth of 8 NB （in AZFc）. In TESE and EJAC cycles, there were no significant differences in embryological and clinical parameters. In TESE-C cycles, there was a significant lower oocyte maturity rate, embryo cleavage rate and mean number of embryos transferred in AZFb, and a higher mean number of oocytes and lower fertilization rate in AZFc. In conclusion, although patients with AZFc microdeletions presented a high testicular sperm recovery rate and acceptable clinical outcomes, cases with AZFa and AZFb microdeletions presented a poor prognosis. Due to the reported heredity of microdeletions, patients should be informed about the infertile consequences on NB and the possibility of using preimplantation genetic diagnosis for female sex selection.

80例非梗阻性无精子症的遗传学分析

本文对 80例非梗阻性无精子症患者进行了外周血染色体、AZF因子和生殖激素检测 ,发现染色体异常的为 2 3例 ,占患者总数的 2 8.75 % ;AZF因子缺失的有 2例 ,占总数的 2 5 % ;Kallmann综合征有 6例 ,占总数的 7.5 %。

Seminal plasma miR-192a： a biomarker predicting successful resolution of nonobstructive azoospermia following varicocele repair

This study was performed to investigate a potential marker for the presence of spermatozoa in the ejaculate following varicocelectomy in Chinese men with nonobstructive azoospermia and varicoceles. The micro-RNA （miR）-192a levels in seminal plasma and testicular tissue were evaluated by quantitative real-time polymerase chain reaction from 60 men with nonobstructive azoospermia and varicoceles （Group A： 27 men with spermatozoa found in the ejaculate after surgery; Group B： 33 men without spermatozoa found in the ejaculate after surgery） and 30 controls. The seminal plasma and testicular tissue miR-192a levels were higher in Group B than in Group A and the controls （P〈 0.001）, and there was no significant difference between Group A and the controls （P〉 0.05）. Apoptosis and proliferation assays with miR mimics and inhibitors showed that miR-192a induced GC-2 cell apoptosis through the activation of Caspase-3 protein. Thus, seminal plasma miR-192a appears to be a potential marker for successfully indicating spermatozoa in the ejaculate following microsurgical varicocelectomy in men with nonobstructive azoospermia and varicoceles. Seminal plasma miR-192a may be a useful clinical marker for prescreening to determine which patients with nonobstructive azoospermia and varicoceles would benefit from varicocelectomy.