Medscape is available in 5 Language Editions – Choose your Edition here.


Sertoli-Cell-Only Syndrome Workup

  • Author: Edward David Kim, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
Updated: Apr 17, 2015

Laboratory Studies

Men undergoing evaluation for infertility typically undergo hormonal evaluation with follicle-stimulating hormone (FSH) and testosterone studies. Luteinizing hormone (LH) and prolactin testing are not routinely necessary. In addition, routine testing for male infertility includes at least two semen analyses. Results are as follows:

  • Plasma testosterone levels are typically normal.
  • Azoospermia and an elevated serum FSH level (>2-3 times reference range) indicate spermatogenic failure.
  • Azoospermia and a serum FSH level within the reference range suggest possible spermatogenic failure or an obstruction.
  • The serum FSH level is typically (90%) elevated. Elevations of greater than 2.5-3 times the reference range are diagnostic for spermatogenic failure.

In its purest sense, SCO syndrome must present as azoospermia; however, a minority of men with the syndrome have foci of spermatogenesis in a testis that is predominantly SCO.

If a couple is considering intracytoplasmic sperm injection (ICSI), a micromanipulation technique in which a single sperm is injected into an oocyte, they should be offered genetic testing with a Y-chromosome microdeletion assay and karyotyping.


Imaging Studies

See the list below:

  • Imaging studies are not indicated in SCO syndrome.

Other Tests

Azoospermia should be documented with a semen pellet analysis. The semen pellet is performed by centrifuging a grossly azoospermic semen specimen for 10 minutes at 1500-2000 rpm. This pellet is considered standard for the diagnosis of azoospermia. The pellet at the bottom of the conical tube is examined under a microscope at a magnification of 400X. If sperm are identified, then patchy spermatogenesis within the testes is present.

Men with SCO syndrome who are azoospermic are at an increased risk of testicular nodules and cancer. As such, the roles of clinical evaluation, ultrasonography, and biopsy should be emphasized.[7]


Histologic Findings

Germinal cell aplasia (SCO syndrome) is histologically characterized by seminiferous tubules that contain only Sertoli cells, with a complete absence of all germ cells. In most cases, the tunica propria and basement membranes are not thickened appreciably, and the tubules are normal or slightly decreased in diameter. The interstitium contains normal numbers of Leydig cells. One may observe a patient with an otherwise classic example of germinal cell aplasia who has an occasional tubule with some degree of spermatogenesis. Levin has classified this as germinal cell aplasia and focal spermatogenesis.



The testis biopsy is the criterion standard for diagnosis of SCO syndrome. Most urologists are familiar with the open biopsy technique. This technique may be performed with a local cord block in most men. Alternatively, a general anesthetic may be used. A small biopsy sample is taken from the surface of the testis and placed in Bouin fixative. Findings on testicular biopsy may include severe hypospermatogenesis, maturation arrest-spermatid stage, maturation arrest-spermatocyte stage, or SCO syndrome.

Men may be offered a testis biopsy to define whether an obstruction or spermatogenic failure is present. If the serum FSH level is greater than 2.5-3 times the reference range and intracytoplasmic sperm injection (ICSI) is not a consideration, the biopsy findings would not change the management plan. If the couple is considering ICSI, a diagnostic biopsy may be helpful to provide counseling regarding the possibility of finding sperm at the time of ICSI. If spermatogenic failure is predominant and rare sperm are identified, testicular extraction of sperm with ICSI may be possible at a later time. At the time of testis biopsy, a specimen may be cryopreserved for potential use of any sperm at a later time.

Some investigators discuss the use of fine-needle aspiration cytology (FNAC) prior to biopsy as a less invasive means of establishing a diagnosis. In addition, this technique can offer prognostic information regarding the likelihood of successful testicular sperm extraction (TESE).

Contributor Information and Disclosures

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.


Joe D Mobley, III, MD, MPH Urologist, Kentucky Lake Urology Clinic

Joe D Mobley, III, MD, MPH is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Endourological Society, Tennessee Medical Association

Disclosure: Nothing to disclose.

Adam F Stewart, MD Resident Physician, Department of Surgery, Division of Urology, University of Tennessee Medical Center, University of Tennessee Graduate School of Medicine

Disclosure: Nothing to disclose.

Jared Moss, MD Resident Physician, Division of Urology, University of Tennessee Graduate School of Medicine

Jared Moss, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Additional Contributors

Erik T Goluboff, MD Professor, Department of Urology, College of Physicians and Surgeons, Columbia University College of Physicians and Surgeons; Director of Urology, Allen Pavilion, New York Presbyterian Hospital

Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, Society for Basic Urologic Research

Disclosure: Nothing to disclose.

  1. Sharpe RM, McKinnell C, Kivlin C, Fisher JS. Proliferation and functional maturation of Sertoli cells, and their relevance to disorders of testis function in adulthood. Reproduction. 2003 Jun. 125(6):769-84. [Medline].

  2. Miyamoto T, Koh E, Tsujimura A, Miyagawa Y, Saijo Y, Namiki M, et al. Single-nucleotide polymorphisms in the LRWD1 gene may be a genetic risk factor for Japanese patients with Sertoli cell-only syndrome. Andrologia. 2013 Feb 28. [Medline].

  3. Yang Y, Ma MY, Xiao CY, Li L, Li SW, Zhang SZ. Massive deletion in AZFb/b+c and azoospermia with Sertoli cell only and/or maturation arrest. Int J Androl. 2008 Dec. 31(6):573-8. [Medline].

  4. Ferlin A, Arredi B, Speltra E, Cazzadore C, Selice R, Garolla A, et al. Molecular and clinical characterization of Y chromosome microdeletions in infertile men: a 10-year experience in Italy. J Clin Endocrinol Metab. 2007 Mar. 92(3):762-70. [Medline].

  5. Hadjkacem-Loukil L, Hadj-Kacem H, Hadj Salem I, Bahloul A, Fakhfakh F, Ayadi H. Genotyping of Tunisian azoospermic men with Sertoli cell-only and maturation arrest. Andrologia. 2011 Jul 6. [Medline].

  6. Kim SK, Yoon YD, Park YS, Seo JT, Kim JH. Involvement of the Fas-Fas ligand system and active caspase-3 in abnormal apoptosis in human testes with maturation arrest and Sertoli cell-only syndrome. Fertil Steril. 2007 Mar. 87(3):547-53. [Medline].

  7. Mancini M, Carmignani L, Gazzano G, Sagone P, Gadda F, Bosari S, et al. High prevalence of testicular cancer in azoospermic men without spermatogenesis. Hum Reprod. 2007 Apr. 22(4):1042-6. [Medline].

  8. Amer M, Haggar SE, Moustafa T. Testicular sperm extraction: impact of testicular histology on outcome, number of biopsies to be performed and optimal time for repetition. Hum Reprod. 1999 Dec. 14(12):3030-4. [Medline].

  9. Anniballo R, Ubaldi F, Cobellis L, et al. Criteria predicting the absence of spermatozoa in the Sertoli cell-only syndrome can be used to improve success rates of sperm retrieval. Hum Reprod. 2000 Nov. 15(11):2269-77. [Medline].

  10. Bettella A, Ferlin A, Menegazzo M, Ferigo M, Tavolini IM, Bassi PF, et al. Testicular fine needle aspiration as a diagnostic tool in non-obstructive azoospermia. Asian J Androl. 2005 Sep. 7(3):289-94. [Medline].

  11. Colpi GM, Piediferro G, Nerva F, Giacchetta D, Colpi EM, Piatti E. Sperm retrieval for intra-cytoplasmic sperm injection in non-obstructive azoospermia. Minerva Urol Nefrol. 2005 Jun. 57(2):99-107. [Medline].

  12. Ferras C, Fernandes S, Marques CJ, et al. AZF and DAZ gene copy-specific deletion analysis in maturation arrest and Sertoli cell-only syndrome. Mol Hum Reprod. 2004 Oct. 10(10):755-61. [Medline].

  13. Hibi H, Ohori T, Yamada Y, Honda N, Hashiba Y, Asada Y. Testicular sperm extraction and ICSI in patients with post-chemotherapy non-obstructive azoospermia. Arch Androl. 2007 Mar-Apr. 53(2):63-5. [Medline].

  14. Nistal M, Jimenez F, Paniagua R. Sertoli cell types in the Sertoli-cell-only syndrome: relationships between Sertoli cell morphology and aetiology. Histopathology. 1990 Feb. 16(2):173-80. [Medline].

  15. Okada H, Dobashi M, Yamazaki T, et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol. 2002 Sep. 168(3):1063-7. [Medline].

  16. Schlegel PN, Palermo GD, Goldstein M. Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia. Urology. 1997 Mar. 49(3):435-40. [Medline].

  17. Sharpe RM, McKinnell C, Kivlin C, Fisher JS. Proliferation and functional maturation of Sertoli cells, and their relevance to disorders of testis function in adulthood. Reproduction. 2003 Jun. 125(6):769-84. [Medline].

  18. Silber SJ. Sertoli cell only syndrome. Hum Reprod. 1996 Jan. 11(1):229. [Medline].

  19. Tournaye H, Liu J, Nagy PZ. Correlation between testicular histology and outcome after intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod. 1996 Jan. 11(1):127-32. [Medline].

  20. Weller O, Yogev L, Yavetz H, Paz G, Kleiman S, Hauser R. Differentiating between primary and secondary Sertoli-cell-only syndrome by histologic and hormonal parameters. Fertil Steril. 2005 Jun. 83(6):1856-8. [Medline].

This hematoxylin and eosin section of a testis biopsy (400X) demonstrates an individual tubule lined only with Sertoli cells (Sertoli-cell-only [SCO] syndrome). The Sertoli cells line the seminiferous tubule.
Interaction between the hypothalamus and the testes. Courtesy of Wikispaces at
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.