Histopathological patterns of testicular biopsy in male infertility: A retrospective study from a tertiary care center in the western part of Saudi Arabia

Abstract

Objective:To identify and categorize various pathological changes seen in testicular biopsies of males with infertility and to compare the results with data from other local and international studies.Materials and Methods:All testicular biopsies from males with infertility received by the Pathology Department of King AbdulAziz University Hospital, Jeddah, in the period from January 2004 until May 2010 are reviewed and histopathologically classified into seven categories as follows : Normal spermatogenesis, hypospermatogenesis, germ cell maturation arrest (GCMA), Sertoli cell only syndrome, seminiferous tubule hyalinization, mixed and discordant patterns.Results:One hundred testicular biopsies were identified in the computerized records of the Department of Pathology of King AbdulAziz University Hospital in the studied period. The age ranged from 22 to 70 years with a mean age of 24.5 years. The histopathological patterns were as follows: 14 (14%) cases were reported as normal spermatogenesis;(29, 29%) cases as hypospermatogesis; and 12 (12%) cases were reported as GCMA, mostly at the level of primary spermatocytes. The Sertoli cell only syndrome and the seminiferous tubule hyalinization categories were each reported in 16 cases (16%). Nine cases (9%) showed a mixed pattern. Discordant pattern was seen in 5 (5%) cases.Conclusion:Our study showed that hypospermatogenesis is the commonest pattern in testicular biopsies taken from males with infertility in our region. This study supports the recommendation of bilateral testicular biopsies when investigating male infertility.

Histopathological pattern of testicular diseases in western Saudi Arabia

“…Most of the studies cited in the discussion appear to observe a mean age above 30 years including this present study, suggesting a possibility that the female partners have to go through detailed investigations before the male partner is submitted to the invasive procedure of testicular biopsies. However, in one study from Jeddah, KSA that observed a younger mean age of less than 25 years, this difference as well as many other observed differences in their study as compared with other studies have not been well understood 24. On the basis of age range, we also noted testicular biopsy for infertility, carried out at a very young age of 13; most likely due to typographic error or other errors of recording, beyond our control.…”

“…A group of Pakistani scientists in their study on evaluation of azoospermia and testicular biopsies reported a mean age of 28 years 23. From within the KSA, a study from the city of Jeddah reported a mean age of 24.5 years 24. Most of the studies cited in the discussion appear to observe a mean age above 30 years including this present study, suggesting a possibility that the female partners have to go through detailed investigations before the male partner is submitted to the invasive procedure of testicular biopsies.…”

Histological findings of testicular biopsy in North Indian population

“…The above classification, has been used by many authors in their studies, 4,[15][16][17][18] There are a few authors who have added a mixed pattern, showing more than one type of pattern in a particular biopsy. 2,19,20 The homogenous mass has not been described in any of the studies cited. In our study tubular hyalinization was the most common cause of male infertility followed by hypospermatogenesis, which is the most common cause according to some studies.…”

“…6 In addition, testicular biopsy is important in the evaluation of men at risk for testicular cancer. 2 The testicular biopsy for infertility requires understanding of a different set of diagnostic categories not otherwise commonly encountered. 3 Studying human spermatogenesis will benefit clinicians, toxicologists, and epidemiologists by direct evaluation of testis or indirectly via evaluations of quantity and quality of sperm ejaculated.…”

“…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 a child. 2 Earlier studies have categorized biopsies into different conditions. In men with azoospermia (sperm count nil), testicular biopsy determines if a blockage is present in the sperm pathway as there is presence of germ cells on histological examination of the testicular tissue.…”