Testis biopsy findings in the spinal cord injured patient

Purpose: Azoospermia after electroejaculation in spinal cord injured men ma y be due to testicular failure or obstruction. These men can initiate pregn ancy with assisted reproductive techniques, such as intracytoplasmic sperm injection, but only if sperm are present in the testis biopsy. We analyzed the histopathology of testis biopsies from spinal cord injured men and asse ssed whether patient factors were predictive of testis biopsy pathology. Materials and Methods: A total of 50 paraplegic men undergoing testis biops y were divided into 2 groups based on normal or abnormal testis histopathol ogy. Patient age, post-injury years, level of lesion, hormonal status and s emen analysis results were compared. Results: Spermatogenesis was normal in 28 of the 50 patients. Hypospermatog enesis was exhibited in 15, maturation arrest at the spermatid stage in 6 a nd maturation arrest at the spermatocyte stage in 1 of the 22 abnormal case s. Nevertheless, mature sperm were identified in 43 of 50 biopsies (normal spermatogenesis and hypospermatogenesis). Men with normal spermatogenesis h ad better forward progression of sperm and a higher testosterone-to-luteini zing hormone ratio. Otherwise, there was no statistically significant corre lation between study variables and testis biopsy results. No factors were p redictive of testis biopsy histopathology. Conclusions: The documentation of mature sperm in 43 of 50 biopsies from sp inal cord injured patients suggests that a high rate of sperm retrieval is possible using testicular sperm extraction if sperm cannot be retrieved fro m the ejaculate. With intracytoplasmic sperm injection techniques the major ity of spinal cord injured men retain fertility potential, even if azoosper mic following electroejaculation.