Testicular biopsy and scrotal exploration in the management of male infertility.

Testicular biopsy findings in 52 subfertile men were correlated with the clinical findings, semen analyses and hormonal levels. Mild to moderate pathological changes were seen in 2/3 of cases while 1/3 had severe damage. Almost 3/4 of them had atrophic testicles while up to 1/2 had varicoceles. In most cases, routine examination, semen analyses and hormonal studies could not provide an accurate guide to the severity of the lesions. Size alone correlated well with worse changes in the smaller testes. Biopsy was more precise for assessing oligospermia and azoospermia in which the histology can vary considerably. The pattern with varicocele was not pathnognonomic but maturation arrest was common in younger patients while older men tend to have sclerosis and intraluminal sloughing irrespective of the grade of venous reflux. FSH and LH levels were only useful when either or both were raised more than 3 times. Normal FSH could be found in germinal aplasia or maturation arrest. In the latter, the testes were often of good size; thus diagnosis would not be made without biopsy. Examination of the testes, epididymis and the vasa was always done at the time of biopsy and when indicated, vasography helped elucidate the nature and site of the obstruction causing azoospermia. When a varicocele was present, biopsy of the testes at the time of ligation can provide assessment of the pathological change and provide a prognosis especially when additional hormonal treatment was being considered. The greatest value of biopsy was in cases confirmed beyond salvage by histology. This enabled appropriate action to be taken ie. AID or adoption, etc.