Understanding Histological Pattern of Testicular Biopsies in North Indian Population for the Management of Male Infertility | Chapter 8 | Medical Science: Recent Advances and Applications Vol. 5

Background: Infertility is defined as the inability to achieve pregnancy after one year of unprotected intercourse. The investigation of male infertility includes history, physical examination, biochemical investigations, semen analysis and testicular biopsy. To interpret the testicular causes, biopsy of the testis and its classification becomes an important tool for diagnosis. Biopsy is mostly done in severe oligozoospermic or azoospermic patients. Biopsies are also important in recent times due to the introduction of Assisted Reproductive Techniques (ART) because they determine the level of spermatogenesis.

 

Aim: The aim of the study is to evaluate histological patterns of testicular biopsies in the North Indian population and re-examine the way of categorising them to improve management of male infertility.

 

Methods: The study was carried out on 30 infertile patients who were either azoospermic (nil to <2 x10⁶ sperms/ml) or severely oligozoospermic (<5 x10⁶ sperms/ml). Testicular biopsy of these patients was taken after obtaining ethical clearance and written consent from the patients. The biopsy was processed, stained and assessed using haematoxylin and eosin and Masson’s trichrome. They were classified into different histological types. They were also categorised by modified Johnsen scoring. The morphology of biopsied tissues was studied qualitatively with respect to the tubules, basement membrane and interstitium. To study the increased connective tissue, Masson’s trichrome staining was used.

 

Results: In the present study, the testicular biopsy has been classified into seven categories. One of the classifications is that of the highly homogenous mass, which is an addition to the studies done previously. The biopsies were classified histologically into obstructive azoospermia in 4 cases (13.33%). Hypospermatogenesis in 5 cases (16.66%), maturation arrest in 3 cases (10%), sertoli cell only syndrome in 3 cases (10%), seminiferous tubule hyalinization in 7 cases (23.33%), mixed patterns in ⁶ cases (20%) and highly cellular homogenous tissue in 2 cases (6.66%). The last condition has not been classified in the literature cited.

 

Conclusions: This study helps to determine the level of spermatogenesis, and by analysing the nature of different germ cells, the findings may be applied in assisted reproductive techniques (ART). Consideration of the biopsy being taken from a particular part of the testis must be kept in mind, and there might be the possibility of spermatogenesis occurring in some other quadrant. The patient needs to be explained this.

 

Author (s) Details

Arpita Mahajan
Department of Anatomy, Maulana Azad Medical College, Delhi University, New Delhi-110002, India.

 

Smita Kakar
Department of Anatomy, Maulana Azad Medical College, Delhi University, New Delhi-110002, India.

J. M. Kaul
Department of Anatomy, Maulana Azad Medical College, Delhi University, New Delhi-110002, India.

 

Sabita Mishra
Department of Anatomy, Maulana Azad Medical College, Delhi University, New Delhi-110002, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v5/5563