TESTIS BIOPSIES FREQUENTLY DEMONSTRATE SPERM IN MEN WITH AZOOSPERMIA AND SIGNIFICANTLY ELEVATED FOLLICLE-STIMULATING-HORMONE LEVELS

Purpose: Men with azoospermia, markedly elevated serum follicle-stimul ating hormone levels and testicular atrophy were previously considered irreversibly infertile. Thus, testicular biopsy in this patient popul ation was considered unnecessary. However, presently men with even the most severe infertility disorders are potentially able to initiate a pregnancy with intracytoplasmic sperm injection provided sperm can be recovered in even relatively few numbers directly from the testicular tissue. For these reasons we sought to reevaluate the findings from te sticular biopsies in these men in the era of advanced micromanipulatio n techniques. Materials and Methods: Chart review identified men with azoospermia, confirmed on a pelleted specimen, and a serum follicle-st imulating hormone level of 3 or more times normal. Mature sperm in the touch preparation cytology and testis biopsy specimen were confirmed. Results: A total of 57 men, most with testicular atrophy, underwent a testicular biopsy and in 17 (30%) mature sperm were identified. The m ost common diagnosis in these men was severe hypospermatogenesis. Men without sperm most commonly had a pure Sertoli-cell-only pattern. Conc lusions: Men with azoospermia and testicular atrophy with significantl y elevated follicle stimulating hormone levels should undergo testicul ar biopsy if in vitro fertilization with intracytoplasmic sperm inject ion is an acceptable approach for the couple.