OBJECTIVE: To determine the expression of the inhibitor of apoptosis survivin in men with and without spermatogenic failure. DESIGN: Prospective case study. SETTING: Two university-based infertility clinics. PATIENT(S): Forty-nine infertile men presenting with azoospermia. INTERVENTION(S): Testicular biopsies for histopathological assessment and analyses of survivin expression levels by real-time reverse transcription-polymerase chain reaction. Survivin levels were normalized to expression of the housekeeping porphobilinogen deaminase gene. MAIN OUTCOME MEASURE(S): Correlation of the histological findings with normalized survivin expression levels. RESULTS(S): Testicular survivin mRNA expression was highest in normal spermatogenesis (n = 14). Decreased expression was observed in patients with spermatogenesis disorders. The expression level correlated with the degree of spermatogenic failure. While it was reduced in postmeiotic maturation arrest (n = 11), a lack of expression was seen in most specimens (10 of 12) with premeiotic maturation arrest and in all of those with Sertoli cell-only syndrome (n = 12). CONCLUSION(S): These data indicate that survivin is expressed in human germ cells and might be involved in apoptosis control during spermatogenesis. Decreased survivin expression in spermatogenic disorders may contribute to the accelerated germ cell apoptosis observed in male idiopathic infertility.
