role of testicular biopsy in male infertility

Summary : The role of testicular biopsy in male infertility IS diagnostic and therapeutic. The diagnostic testicular biopsy is to differentiate between obstructive and non-obstructive azoospermia and to determine the pathological lesion. Diagnostic testicular biopsy is performed only on azoospermic patients, And most clinicians perform bilateral testicular biopsy, but in patients withdiscrepant testicular volume, some physicians perform a biopsy on the larger testis only. Patients with clinical findings that are pathognomonic for either obstruction, such as bilateral absences of the vasa or testicular failure, do not require a testicular biopsy to establish the cause of their azoospermia. Clinical findings pathognomonic for testicular failure include bilateral small testes and/or a markedly elevated serum FSH. Thus, a diagnostic testicular biopsy is only needed in those patients in whom ductal obstruction is suspected based on the presence of a relatively normal serum FSH and testicular volume. The other role of testicular biopsy is in the management of patients with non-obstructive azoospermia who are considering sperm retrieval and IVF. In this setting, a testicular biopsy may be performed to obtain prognostic information, but this assessment is of limited value because sperm may be found with more extensive dissection in men with all histopathologic types and the presence of sperm on one biopsy does not 129,