A Practical Approach to Testicular Biopsy Interpretation for Male Infertility

Abstract

Context.—The combination of testicular biopsy and clinical evaluation for male infertility is becoming progressively more important because new technologies allow men previously considered infertile to father children. Although most general pathologists are experienced with normal, neoplastic, and cryptorchid testicular specimens, the testicular biopsy for infertility requires understanding of a different set of diagnostic categories not otherwise commonly encountered. Objective.—To highlight a standardized nomenclature for germ cell abnormalities allowing for effective communication with the urologist and maximal clinical benefit from the biopsy. Data Sources.—Previously published consensus statements, review articles, peer-reviewed research publications, and abstracts. Conclusions.—A practical approach to evaluating testicular biopsies for fertility and the clinical implications for each abnormality are herein outlined.

Formalin Versus Bouin Solution for Testis Biopsies: Which Is the Better Fixative?

“…Fifteen percent of couples are affected by infertility, and approximately 50% of infertile couples have some male factor. [1][2][3] Failure to conceive after 1 year of unprotected intercourse often leads both male and female partners to undergo fertility evaluations. The AUA Best Practice statement on male infertility summarizes the goal of the infertility evaluation to recognize and treat reversible conditions, to categorize disorders potentially amenable to assisted reproductive techniques (ART), to identify syndromes and conditions which may be detrimental to the patient's health, and to distinguish genetic abnormalities which can be transmitted to or affect the health of the offspring.…”

“…2,5 Testicular biopsy interpretation is important to differentiate between obstruction and a disorder of spermatogenesis and in some instances, the findings are predictive of successful sperm retrieval. 1,6,7 Due to concern that common fixatives, such as formalin, may distort the architecture of testicular tissues, Bouin solution has traditionally been the recommended fixative for testis biopsy specimens. 1,2 Bouin solution is a preparation of 5% acetic acid, 9% formaldehyde, and 1.5% picric acid in aqueous solution.…”

“…1,6,7 Due to concern that common fixatives, such as formalin, may distort the architecture of testicular tissues, Bouin solution has traditionally been the recommended fixative for testis biopsy specimens. 1,2 Bouin solution is a preparation of 5% acetic acid, 9% formaldehyde, and 1.5% picric acid in aqueous solution. The picric acid in Bouin solution presents challenges for safe handling and disposal due to its mutagenic and explosive potential.…”

“…This could potentially hamper assessment of the stages of sperm development. 1,4 Formalin offers advantages over Bouin solution, however, in its ease of use, availability as a common fixative used in histology labs, and lack of explosive potential. For the past several years at our institution, formalin has been used as a fixative for testis biopsies due to regulations restricting the presence of Bouin solution in operating rooms.…”

Histopathological Evaluation of Non-Obstructive Azoospermic Males Using Testicular aspirate (TESA) biopsy

“…[2,3] Male infertility causes can be subdivided into three main categories; pretesticular, testicular & post testicular. [4] Azoospermia simply defined as complete absence of spermatozoa in the ejaculated semen for at least two times & its account for about 1% of male population & 10 % of infertile male. [5] For male infertility evaluation, it's very important to have a comprehensive clinical history & complete physical examination along with hormonal profile and semen analysis [3] , however different testicular phenotype changes can't be predicted accurately through these parameters mentioned above only, so clinicians recommended testicular biopsy and / or testicular sperm aspiration (TESA) to the accurate evaluation of the spermatogenesis and any pathological conditions.…”