Azoospermia India

What is new?

A new understanding of testicular histology in azoospermia


Testicular biopsy – old interpretation

Azoospermia India - Dr. Vijay Kulkarni, Andrologist  

Now we realize that there is a minimum amount of spermatogenesis required for sperm to appear in the semen.In a man with azoospermia who has no anatomical obstruction there may still be a few sperm in his testes

Testicular biopsy – old interpretation

Azoospermia India - Dr. Vijay Kulkarni, Andrologist

Testicular biopsy – a new interpretation

Azoospermia India - Dr. Vijay Kulkarni, Andrologist

Pattern of spermatogenesis in men with testicular failure

Azoospermia India - Dr. Vijay Kulkarni, Andrologist

Testicular biopsy – a new approach

Diagnostic single biopsy should be replaced by
Testicular Mapping Biopsies

  • multiple : 4-6
  • identified by quadrant or hextant
  • bilateral

What is New?

Better understanding of the inter-relationship between F.S.H. and Testicular Histology

FSH & Spermatogenesis

  • Normal FSH does not necessarily mean normal spermatogenesis
  • Many azoospermic men with maturation arrest with have normal FSH
  • Many azoospermic men with normal FSH will have maturation arrest
  • Elevated FSH = Testicular Failure
  • However, elevated FSH does not exclude the presence of a few sperm enough for ICSI

What is New?

New techniques of testicular biopsy

  • less invasive
  • less traumatic

Testicular Sperm Retrieval Techniques

  1. Needle Aspiration Biopsy (NAB)
  2. Single Seminiferous Tubular (SST) biopsy technique

What is New?

Genetic causes of Azoospermia

  • Numerical chromosomal anomalies
  • Structural chromosomal anomalies
    • Yq deletions
    • Autosomal deletions and translocations
    • Androgen receptor gene defects
    • CFTR gene mutations
    • Inheritable
    • Predict presence of sperm
    • Indicate risk of other disease

PESA-ICSI

  • Prior biopsy is not required
  • IVF centres may do trial PESA with cryopreservation

Azoospermia, Fructose positive

Azoospermia India - Dr. Vijay Kulkarni, AndrologistAzoospermia India - Dr. Vijay Kulkarni, AndrologistAzoospermia India - Dr. Vijay Kulkarni, Andrologist

INTRA CYTOPLASMIC SPERM INJECTION

A single sperm is adequate to produce a baby
Testicular-biopsy-old-interpretation

In Summary

  • Not every azoospermic man needs a biopsy
  • Initially needle biopsy
  • If open biopsy
    • multiple, mapping, SST technique
    • Collaboration with IVF unit
    • Genetic testing

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