Role of FNAC mapping to guide directed sperm retrieval in infertile males for in-vitro fertilisation (IVF)

Abstract

Background: Focal areas of spermatogenesis may exist in men even with small atrophic testis, raised follicle stimulating hormone (FSH) and in men previously considered to be having absence of spermatogenesis such as sertoli cell only syndrome. The study conducted by us has evaluated the regional differences in spermatogenesis by fine needle aspiration cytology (FNAC) mapping according to a standard template. This study aims at finding a possibility of directed sperm retrieval from region with better spermatogenesis for use in assisted reproduction techniques and intra-cytoplasmic sperm injection. Aimsand Objectives: The study was conducted with an aim to compare histological grading of spermatogenesis in testicular tissue by FNAC and biopsy in infertile males and to map the pattern of spermatogenesis in the testis of infertile males. Materials and Methods: Forty azoospermic men were taken into study and everyone underwent FNAC from eight different segments of one testis. They further underwent open biopsy from the segment, which showed better spermatogenesis. Results of FNAC and biopsy were compared. Results: Frequency of normal spermatogenesis was equivalent in all segments of testis by FNAC mapping (P value = 0.986). Sperm detection rate was 90% by eight-segment FNAC mapping in azoospermic participants. Correlation between results of FNAC and biopsy showed 85% concordance and 15% discordance. The eight-segment FNAC mapping showed sensitivity of 100%, specificity of 44.5%, and accuracy rate of 87.5% in detecting normal spermatogenesis. Conclusion: It is recommended to do FNAC mapping for every nonobstructive azoospermic subject, before undergoing retrieval procedure for better localization of spermatogenesis.