A PROSPECTIVE-STUDY OF MULTIPLE NEEDLE BIOPSIES VERSUS A SINGLE OPEN BIOPSY FOR TESTICULAR SPERM EXTRACTION IN MEN WITH NONOBSTRUCTIVE AZOOSPERMIA

Little is known about the efficacy and the factors affecting the outco me of fine needle aspiration biopsy of the testis for sperm retrieval in azoospermic men with defective spermatogenesis. A prospective study was designed to compare the efficacy of needle and open (window) test icular biopsies for testicular epididymal sperm extraction (TESE) in 3 5 consecutive men with azoospermia due to defective spermatogenesis un dergoing testicular biopsy for intracytoplasmic injection of oocytes, Each of the consecutive 35 patients underwent TESE using a 19 gauge bu tterfly needle followed by a window (1-1.5 cm-sized incision) testicul ar biopsy in the same procedure. The extraction of spermatozoa into cu lture medium was compared with the assessment of testicular biopsies b y histology, the mode of biopsy (needle or open biopsy) and the amount of tissue retrieved by either method. Testicular spermatozoa were ret rieved in 22 (63%) who had an open testicular biopsy compared with fiv e (14%) patients who had multiple needle biopsies, respectively; the d ifference was statistically significant. Open testicular biopsy retrie ves more testicular tissue than needle biopsy. Needle testicular biops y retrieved testicular spermatozoa in 50% of those with hypospermatoge nesis, 10% with focal spermatogenesis and in no patients with maturati on arrest or Sertoli cell-only pattern, In contrast, sperm retrieval w as successful in 100%, 90% and 66% of those with respective histologie s using open testicular biopsy. Other than bruising, for which they re quired no analgesia, none of the patients suffered any obvious complic ations associated with traditional testicular biopsy. We conclude that open testicular biopsy is more effective than needle biopsy for the r etrieval of testicular spermatozoa in azoospermic men with defective s permatogenesis. The difference observed may be related to the amount o f testicular tissue retrieved and to the influence of testicular histo logy.