For many years Testicular biopsy was considered the gold standard for diagnosis in men with unexplained infertility. However recent guidelines have limited the indications for a diagnostic testicular biopsy and there is paradigm shift towards prognostic and therapeutic significance.
1. To re-evaluate the role of testicular biopsy in male factor infertility and guide in planning the management protocols.
2. To identify potential candidates who would benefit from assisted reproductive techniques.
Settings and Design:The present study was conducted at the Department of pathology, Kamineni Institute of Medical Sciences, Narketpally over a period of 3 years, starting from June 2015 to June 2018. This study was a prospective study.
Material and Methods:This study involved schematic evaluation of cases with male infertility which included clinical history, physical examination, semen analysis, hormone analysis, radiological evaluation (Scrotal and trans-rectal Ultrasonography) for obstructive etiology and finally testicular biopsy. Histomorphology of Testicular biopsy specimens were analyzed and the results were documented.
Statistical analysis used: Simple percentages and Graphical representation of the data.
Results: Testicular biopsy done in 71 patients revealed Hypo-spermatogenesis as the most common histological finding. Second most common abnormality reported was Sertoli cell only syndrome/Germ cell aplasia. Majority of cases of Varicocele, inguinal hernia and radiologically documented obstructive cases revealed normal spermatogenesis. And using microsurgical assisted reproduction techniques, sperms were retrieved from all cases of Hypo-spermatogenesis. Sperm retrieval rates were 70% and 31.3% in maturation arrest and Sertoli cell only syndrome respectively.
Conclusions: Testicular biopsy in the management of Male factor infertility carries prognostic significance. In patients with obstructive azoospermia, presence of normal spermatogenesis and hypo-spermatogenesis carries good prognosis as surgical repair of the defects recovers fertility in majority of cases. In cases with non-obstructive azoospermia with findings of hypo-spermatogenesis, Sertoli cell only syndrome and maturation arrest, testicular biopsy predicts the chances of sperm retrieval by microsurgical TESE for intracytoplasmic sperm injection (ICSI) and thus carries prognostic and therapeutic significance.