Author(s): Sujata Naik1, Manoj Kumar Patro2, Jayanti Nayak3, Debi Prasad Mishra4
Infertility continues to be a significant problem since ages. Studies suggest that the problem affects 8-12% of couples across the globe, and among these affected couples, approximately 50% cases are contributed by the male partner. Semen analysis is the first investigation that indicates towards male factor in infertility. Finding the cause of infertility in cases of severe oligozoospermia and azoospermia by evaluating testicular biopsies has now become essential with the availability of Assisted Reproductive Techniques (ART), which gives information about the level of spermatogenesis. The present study was undertaken to detect the histological findings in cases of male infertility in this geographic region.
MATERIALS AND METHODS
A prospective cross-sectional study was undertaken in which testicular biopsies received from 52 infertile male patients with seminogram impressions of very severe oligozoospermia and azoospermia constituted the study group. Detailed clinical data including the LH. FSH and testosterone hormone levels were recorded. Tissue samples were routinely processed and Haematoxylin and Eosin stained were made. Modified Johnsen scoring was used to categorise each case.
86.5% cases in the study group were found to have azoospermia and rest 13.5% cases had severe oligozoospermia. All the cases were histologically classified into six categories- obstructive pathology 25 of 52 cases (48.1%), pure germ cell aplasia 14 of 52 cases (26.9%), maturation arrest 7 of 52 cases (13.5%), atrophic testis 4 of 52 cases (7.7%), hypospermatogenesis 1 of 52 cases (1.9%) and inconclusive in 1 of 52 cases. Serum FSH and serum LH levels were found significantly raised in cases of pure germ cell aplasia and atrophic testis in contrast cases of obstructive aetiology had normal levels. Modified Johnsen scoring values were 9 in cases with obstructive pathology, 1/2 only in cases of pure germ cell aplasia and atrophic testes and 3 to 6 in cases of maturation arrest.
The present study concludes that testicular biopsy is of value in determining the level of spermatogenesis as well as the cause of infertility. The former information will help in deciding the mode of assisted reproductive technology suitable for the individual.
Testicular Biopsy, Male Infertility, Johnsen Scoring, Histological Classification, Azoospermia, Oligozoospermia.