Bathen Holly A, Wood Ellen
Research, Lake Erie College of Osteopathic Medicine, Bradenton, USA.
Reproductive Endocrinology and Infertility, IVFMD, Cooper City, USA.
Cureus. 2020 Aug 31;12(8):e10165. doi: 10.7759/cureus.10165.
Sarcoidosis is a multisystem disease that can affect any region of the body. Rarely, sarcoid involvement may even involve the male genitourinary tract, including the testicles. Testicular sarcoidosis causes spontaneous and severe effects on male fertility due to obstructive azoospermia. The case presented offers an insight into successful fertility treatment in a patient with obstructive testicular sarcoidosis. The patient and his partner presented to the clinic two years post successful natural conception of their first child with subsequent infertility. Within this period, the male partner was diagnosed with sarcoidosis and was on a treatment plan consisting of methotrexate and glucocorticoids. Complete azoospermia was confirmed via two separate semen analyses six weeks apart. The patient's testosterone (free and total), thyroid stimulating hormone (TSH), prolactin, follicle stimulating hormone (FSH), and luteinizing hormone (LH) were all within normal limits. With approval of pulmonology, methotrexate was discontinued for three months; however, subsequent semen analysis revealed no improvement. The patient was referred to urology, who confirmed the presence a palpable testicular nodule. Treatment of infertility was eventually achieved via testicular sperm aspiration (TESA) followed by in vitro fertilization (IVF) using intracytoplasmic sperm injection (ICSI). This treatment was successful in achieving one blastocyst and one morula, which were replaced via fresh transfer, resulting in a successful term singleton pregnancy. The possibility of obstructive azoospermia should be considered in males diagnosed with sarcoidosis who are seeking to preserve their reproductive potential.
结节病是一种多系统疾病，可累及身体的任何部位。很少见的是，结节病甚至可能累及男性泌尿生殖道，包括睾丸。睾丸结节病由于梗阻性无精子症会对男性生育能力产生自发且严重的影响。本文所呈现的病例为一名患有梗阻性睾丸结节病的患者成功进行生育治疗提供了见解。该患者及其伴侣在成功自然受孕第一个孩子后两年因后续不孕前来诊所就诊。在此期间，男性伴侣被诊断出患有结节病，并正在接受由甲氨蝶呤和糖皮质激素组成的治疗方案。通过相隔六周的两次独立精液分析证实为完全无精子症。患者的睾酮（游离和总睾酮）、促甲状腺激素（TSH）、催乳素、促卵泡激素（FSH）和促黄体生成素（LH）均在正常范围内。经肺病科批准，甲氨蝶呤停药三个月；然而，随后的精液分析显示无改善。患者被转诊至泌尿外科，后者确认存在可触及的睾丸结节。最终通过睾丸精子抽吸术（TESA），随后使用卵胞浆内单精子注射（ICSI）进行体外受精（IVF）实现了不育治疗。该治疗成功获得了一个囊胚和一个桑葚胚，并通过新鲜移植进行植入，从而成功实现了足月单胎妊娠。对于被诊断患有结节病且寻求保留其生殖潜能的男性，应考虑梗阻性无精子症的可能性。
