Unilateral or Bilateral Testicular Biopsy in the Era of Intracytoplasmic Sperm Injection

Abstract

Bilateral testicular biopsies are superior to unilateral biopsies in the evaluation of patients with azoospermia. A 28% intra-individual difference in testicular pathology was seen after bilateral biopsies, and in 20% of patients focal spermatogenesis would have been missed after unilateral biopsy only. Due to the prognostic relevance of testicular biopsies for successful sperm retrieval before assisted reproduction, bilateral diagnostic testicular biopsies are recommended in the evaluation of patients with azoospermia.

Patterns of Testicular Cytology in Men with Primary Infertility

“…The morphologic changes in this cohort were comparable in many aspects to those in other studies in the region and worldwide 5,11,12,14,[21][22][23][24][25] (Table I). This study supports a conclusion by Schoor et al 26 that males with high FSH and smaller testes have nonobstructive lesions and are best counseled accordingly.…”

Effect of testicular spermatozoa on embryo quality and pregnancy in patients with non-obstructive azoospermia

“…In NOA, patient age, testicular size, and various molecular markers (e.g., FSH receptor genes) have been determined to be predictive parameters for successful spermatozoa retrieval before assisted reproduction [Gil-Salom et al 1998;Plas et al 1999;Song et al 2000]. These different results may be due to differences in patient selection in terms of FSH concentration and/or testis size before biopsy, degree of spermatogenic defect [Plas et al 1999], number of testicular biopsies, laboratory techniques used for testicular spermatozoa preparation and spermatozoa selection, protocol of ovarian Values in parentheses are percentages.…”

“…These different results may be due to differences in patient selection in terms of FSH concentration and/or testis size before biopsy, degree of spermatogenic defect [Plas et al 1999], number of testicular biopsies, laboratory techniques used for testicular spermatozoa preparation and spermatozoa selection, protocol of ovarian Values in parentheses are percentages. p50.05 is considered significant; NS: not significant.…”

“…Histopathology must be performed for accurate diagnosis of NOA; patients can be further classified into NOA subgroups (HS, MA, and SCO) using histopathology [Giorgetti et al 2005]. Histopathology has also been shown to be the only reliable predictor of successful TESE Plas et al 1999]. Recent studies reported that, although testicular histopathology is the strongest predictor of sperm retrieval in men with NOA, testicular histopathology does not have any influence on outcome of microdissection TESE for ICSI [Abdel Raheem et al 2013;Karacan et al 2013].…”

836 The validity of testicular aspirate cytology and DNA image analysis of the aspirate in the assessment of infertile men

“…spermatogenic arrest in two and SCO in two. This finding could be explained in that active spermatogenesis might be focal or limited to some seminiferous tubules, and an open testicular biopsy (which is a single-site biopsy) might miss these areas, while FNA can be taken from the upper, middle and lower poles of each testis, and can precisely evaluate testicular spermatogenesis [25,26].…”