Abstract
Background: Male infertility is a common problem and needs a minimally invasive method to arrive at the appropriate diagnosis. Alternative to open testicular biopsy the fine needle aspiration cytology (FNAC) of the testis is being increasingly used as a minimally invasive method of evaluating testicular function. Aim: To determine the causes of azoospermia and evaluate the efficacy of FNAC as compared to open testicular biopsy in evaluating azoosparmic men by correlating diagnosis from testis FNAC with biopsy histology. Patients and Methods: We prospectively studied 67 consecutive infertile patients who referred to andrology department of Al-Yarmouk Teaching hospital, Baghdad, Iraq between (January 2010-January 2014). All patients were azoospermic. They underwent bilateral testicular fine needle aspiration for cytological evaluation as well as bilateral testicular biopsy for histopathological correlation. Results: The morphological diagnosis revealed normal spermatogenesis in 12 patients (17.9%), hyposparmatogenesis in 4 (5.9%), spermatogenic arrest in 39 (58.2%), Sertoli cell only in 7 (10.4%), and complete tubular hyalinization in 5 patients (7.4%). Good correlation between the 2 methods was found in 120 (91.6%) testes which was identical in the right and left testis. Discrepancies between cytology and histology were mainly the result of insufficient and scanty smears. Conclusion: Testicular FNAC is a simple and minimally invasive alternative method to open testicular biopsy in the investigation and assessment of patients with azoospermia.
Highlights
Azoospermia, defined as the absence of spermatozoa in the ejaculate after assessment of centrifugated semen on at least 2 occasions, affects approximately 1% of the male population & 10% of men who seek fertility evaluation [1].The etiology of azoospermia may be attributed to 1) pre-testicular causes, 2) testicular causes, or 3) post testicular causes [2].To distinguish between obstructive & non-obstructive azoospermia testicular biopsy may be performed
Surgical biopsy of the testis has generally been regarded as the gold standard in the evaluation of male infertility [3], testicular fine needle aspiration (FNA) is considered as an alternative method that has gained increasing popularity as a simple, minimally invasive procedure that can help in assessing testicular function accurately [3]-[7]
We had done this study to determine the causes of azoospermia and evaluate the efficacy of fine needle aspiration cytology (FNAC) as compared to open testicular biopsy in evaluating azoospermic men by correlating diagnosis from testis FNAC with biopsy histology
Summary
Azoospermia, defined as the absence of spermatozoa in the ejaculate after assessment of centrifugated semen on at least 2 occasions, affects approximately 1% of the male population & 10% of men who seek fertility evaluation [1].The etiology of azoospermia may be attributed to 1) pre-testicular causes (e.g., endocrine abnormalities causing secondary testicular failure), 2) testicular causes (e.g., primary testicular failure due to intrinsic disorders of spermatogenesis within the testis, including maturation arrest, complete absence of germ cells or Sertoli cellonly syndrome), or 3) post testicular causes (e.g., ejaculatory dysfunction or ductal obstruction that prevent sperm transport) [2].To distinguish between obstructive & non-obstructive azoospermia testicular biopsy may be performed. Surgical biopsy of the testis has generally been regarded as the gold standard in the evaluation of male infertility [3], testicular fine needle aspiration (FNA) is considered as an alternative method that has gained increasing popularity as a simple, minimally invasive procedure that can help in assessing testicular function accurately [3]-[7]. Both methods give a clear assessment of spermatogenesis and allow a rational choice for the future management of the couple by reconstructive surgery, hormonal therapy, artificial donor insemination or adoption [8]. Conclusion: Testicular FNAC is a simple and minimally invasive alternative method to open testicular biopsy in the investigation and assessment of patients with azoospermia
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