2. Purpose:
• Testicular biopsy is used in cases of infertility in males with
azoospermia; to define the cause of azoospermia; obstructive or non-
obstructive
• When the hormonal profile is inconclusive, a biopsy can provide
definitive evidence of spermatogenic activity
• Testicular biopsy can also be used for sperm retrieval in azoospermic
pts for ICSI (Intra Cytoplasmic Sperm Injection)
4. Methods
• Open incisional biopsy or Wedge
biopsy :
2-3 cm incision to obtain a piece of
testicular tissue
• Percutaneous biopsy:
Obtained by a syringe & needle
through the scrotum into the testicular
parenchyma
5. Adequacy of the biopsy:
• Grossly: At least 3 mm
• Microscopically:
3-5 lobules with septa
• Fixation of the biopsy is very important
and best done using Bouin’s solution
6. Evaluation of testicular biopsy
Should be done for:
1.Overall morphology
2.Size & structure of seminiferous tubule
3.Interstitial tissue
4.Spermatogenesis
5: Quantitative assessment
7. The normal testis
• The S.Ts contain two types of cells
contain 2 types of cells: Germ cells &
Sertoli cells
• Spermatogenesis is a continuous
process
• All tubules show active
spermatogenesis and germ cells are
present in various stages
• The number late spermatids correlates
with the number of sperm count
10. Hypospermatogenesis
• All stages of spermatogenesis are present but reduced
• May be due to hormonal dysregulation, androgen insensitivity,
exposure to heat, radiation or chemicals
• With prolonged exposure, there maybe some tubules containing
Sertoli cells only or hyalinized tubules mixed with other tubules
showing complete spermatogenesis
• The reduction may be mild moderate or severe
11.
12. Germ cell maturation Arrest
• This is interruption of development and differentiation of germ cells
at a certain stage
• It is of two types; complete and incomplete
• Complete: Germ cell maturation arrest at a specific point , commonly
at the primary spermatocyte level in all tubules, the sperm count
usually zero
• Incomplete: The arrest is present in many tubules but some tubules
still show maturation and late spermatids are seen
13.
14. Sertoli cell only Syndrome
• Also known as Germ cell aplasia
• Seminiferous tubules contain only one type of cells, Sertoli cells
• In some pts, there may be some tubules exhibiting reduced
spermatogenesis where we see very low sperm count
• Four types of Sertoli cells are identified:
1. Normal cells
2. Immature cells
3. Dysgenetic cells
4. Involuting cells
15.
16. Tubular hyalinization
• The tubules are fibrosed and hyalinized with peritubular fibrosis
• Commonly seen in klinfelter syndrome, hypoprolactinemia and
postpubertal androgen/estrogen excess
• Usually, the number of Leydig cells is increased but the function is
impaired
17.
18. Intratubular germ cell neoplasia
• It is an in situ stage of germ cells neoplasia
• The tubules are lined by large atypical cells with clear cytoplasm
• The basement membrane is thickened
• The spermatogenesis is absent
• It is subdivided into intratubular seminoma, intratubular non-
seminoma. Intratubular yolk sac tumor and intratubular teratoma
• Immuno-stains can be used for diagnosis and further typing e.g. PLAP,
oct 3/4, CD117, D2-40, SALL4…
21. Role of testicular biopsy in assisted
reproductive techniques
• In pts with azoospermia, spermatozoa can be retrieved from the testis
using different methods such as:
1. TESE: Testicular sperm extraction
2. TESA: Testicular sperm aspiration
3. MicroTESE: Microdissection sperm extraction
• Testicular mapping: can be done to define sperm spots to increase
the chances of success
22. Take home message
• Testicular biopsy is a definitive diagnostic tool, can guide treatment
dissension and assist in sperm retrieval
• It is rather safe with minimal risk of bleeding or infection
• Advances in biopsy techniques and molecular diagnostics can improve
the accuracy and safety of the procedure
