The Role of Testicular Biopsy in the Modern Management of Male Infertility

Abstract

In the vast majority of patients obstructive azoospermia may be distinguished clinically from nonobstructive azoospermia with a thorough analysis of diagnostic parameters. Based on this result, we believe that the isolated diagnostic testicular biopsy is rarely if ever indicated. Men with FSH 7.6 mIU/ml. or greater, or testicular long axis 4.6 cm. or less may be considered to have nonobstructive azoospermia and counseled accordingly. These men are best treated with therapeutic testicular biopsy and sperm extraction, with processing and cryopreservation for usage in in vitro fertilization and intracytoplasmic sperm injection if they accept advanced reproductive treatment. Diagnostic biopsy is of no other value in this group. Men with FSH 7.6 mIU/ml. or less, or testicular long axis greater than 4.6 cm. may elect to undergo reconstructive surgery with or without testicular biopsy and sperm extraction, or testicular biopsy and sperm extraction alone depending on their reproductive goals.

Testicular sperm aspiration in men with presumed non-obstructive azoospermia: Analysis of FSH level as a predictor of successful sperm retrieval

“…Testicular size was determined by measuring the longitudinal dimension of each testicle with a ruler. Schoor et al found that a longitudinal testicular length of greater than 4.6 cm has a 72% sensitivity and 78% specificity of diagnosing OA [5] . We used a similar criterion to exclude patients from the study if they had a documented longitudinal length of greater than 4.6 cm which would suggest OA.…”

Case – Azoospermia with bilateral varicocele and normal follicle-stimulating hormone

“…5,9 Relevant historical factors in the evaluation of azoospermia are listed in Table 1 12 These findings are reflected in current guidelines on the evaluation of azoospermia and have greatly reduced the need for testicular biopsy in the evaluation of azoospermia. 5,9 The purpose of this case report is to discuss a diagnostically challenging presentation of azoospermia in the context of current recommendations and to propose a situation-specific treatment algorithm to aid in the management of azoospermia and varicocele.…”

Testicular histopathological diagnosis as a predictive factor for retrieving spermatozoa for ICSI in non-obstructive azoospermic patients

“…According to Schoor et al (2), a testis biopsy could promote scars that make the following biopsy procedures more difficult. Sousa et al (4) consider testicular biopsy the best method for sperm retrieval in non-obstructive azoospermic patients, considering that in testicular atrophy cases percutaneous sperm aspiration was not able to provide enough material for ICSI.…”

“…Considering that spermatogenesis recovery after a biopsy procedure is slow, it is essential to avoid unnecessary biopsies (16). A maximum of 3 procedures must be performed and, whenever possible, they should be associated with cryopreservation techniques (4,2). This care reduces the risk of complications without impairing fertilization and pregnancy rates (16).…”

“…Men with nonobstructive azoospermia could be biological fathers due to the possibility of testicular sperm extraction (1,2). High rates of sperm retrieval in ICSI procedures performed with sperm retrieved by testicular biopsy have been described (3).…”