Not many of us would have heard of SCOS (Sertoli Cell-Only Syndrome). Sertoli cells are one of the essential cells required for sperm production. They are usually big, tightly-knit cells situated at the base and towards the sides of the seminiferous tubules in the testes. Germ cells are the other most important cells for producing sperm, and together, these cells work in the male reproductive system. A semen analysis lab plays a crucial role in diagnosing conditions like SCOS by evaluating these essential cells and their function in sperm production.
Definition:
SCOS is also known as germ cell aplasia or del Castillo syndrome. It is a condition where only sertoli cells line the seminiferous tubules in the testes and germ cells are absent. Usually, sertoli cells nourish and support the developing germ (sperm) cells within the tubules. Because of no germ cells being present, it affects male fertility. It is one of the most common causes of azoospermia (no sperm in the ejaculate) or very low spermatogenesis.
Symptoms:
Typically, patients with SCOS are in the age group of 20 to 40 years. They are usually normal on physical examination as there is no sexual abnormality. The method for diagnosis is by testicular biopsy, where a sample of tissue from the testes is inspected under a microscope. The diagnosis is confirmed if only sertoli cells are present and no germ cells are found. Symptoms would show azoospermia or infertility. Testicular atrophy (where the testis or both testacles are smaller than normal size) is another symptom. Sertoli cells respond to the follicle-stimulating hormone (FSH), which is required to determine the number of sertoli cells and for producing and maintaining normal sperm. If the FSH levels are high, it could be another symptom of SCOS.
Causes:
The exact causes of SCOS have not yet been identified. They could be multifactorial, involving:
- Genetic: Certain genetic defects can lead to SCOS. Microdeletions on the Y-chromosome (specially in the azoospermia factor (AZF) region) could be a cause.
- Environmental or Lifestyle: Exposure to chemicals or toxins, radiation, extreme heat in the testicular area or other testicular trauma could contribute to SCOS.
- Autoimmune: Some cases have been defined by autoimmune responses where the body’s own germ cells are attacked by mistake.
Treatments:
At present, there is no specific cure for patients with SCOS.
- ART (assisted reproductive procedures): However, in certain cases, there is hope for patients with very low sperm counts or even no sperm in the ejaculate (azoospermia). Micro-TESE (microscopic testicular sperm extraction) tests can micro-surgically extract sperm directly from the patient’s testes. This method of sperm retrieval has a higher success rate than TESA (testicular sperm aspiration), which is performed with a simple needle stick and does not require skilled microscopic surgery. Such sperm extracted can be used for IVF by ICSI (intracytoplasmic sperm injection) to fertilise an egg. However, the rate of successful sperm retrieval from SCOS patients varies significantly, depending on multiple factors. The presence of a small number of sperm cells and the experience of the surgeon can influence the outcome of micro-TESE/TESA tests and ICSI. Generally, the rate of successful fertilisation from ICSI is usually lower in men with non-obstructive azoospermia (no sperm in the ejaculate due to failure of spermatogenesis) than in men with obstructive azoospermia (the absence of sperm despite normal spermatogenesis).
- Donor sperm: Using donor sperm is an option for artificial insemination for many couples.
- Emotional support: Counselling and psychological support can assist couples dealing with the trauma of infertility.
At Andrology Center, we offer both the manual semen analysis, as per WHO norms, and the AI semen analysis. These are the basic tests to check male fertility. With our state-of-the-art equipment and technology, we offer the more progressive SDF (Sperm DNA Fragmentation) test. It is with pride we state that we are the only authorised laboratory in India to perform the genuine SCSA® (sperm chromatin structure assay) test, which guarantees accurate results.
Now, under one roof, we are offering additional tests, including Blood Tests (hormone assays and serology tests), Sperm Aneuploidy and Y-chromosome Microdeletion, which could help in identifying SCOS.
We provide standardised reports. This simplifies it for the fertility specialist to provide improved patient care. By discussing options with the patient/couple, the specialist can make informed decisions to use the most beneficial treatments leading to a successful outcome.
