Heterogeneity of the Testis, an Important Clinical Fact for Infertile Azoospermic Men Undergoing Fine Needle Aspiration of the Testis.
Sohaib H Abu-Farsakh, Hussam A Abu-Farsakh. Jordan University, Amman, Jordan; First Medical Lab, Amman, Jordan
Background: Azoospermic infertile male patients have to resort to testicular fine needle aspiration to search for sperms. These sperms can be used for intracytoplasmic sperm injection into the partner's ova in the assisted reproduction procedure. Finding sperms in the testis is of paramount importance for such couples.
Design: 1620 azoospermic patients had undergone testicular fine needle aspiration for the assessment of their spermatogenesis status. Each patient has been sampled from 10 specific locations, 5 from the right testis and 5 from the left testis, using 27 gauge needles. Patients are classified according to the presence or absences of sperms and its quantity into the following stages: I) Sertoli cells only, II) Spermatogenesis arrest at early stage, III) Spermatogenesis arrest at late stage, IV) sperm heads only V) Hypospermatogenesis (sperms were seen) and VI) Obstructive azoospermia. Hypospermatogenesis is also divided into 4 classes according to the amount of sperms: A) very marked Hypospermatogenesis, B) marked Hypospermatogenesis C) moderate Hypospermatogenesis D) mild Hypospermatogenesis. In each patient, the testis is classified as homogenous or heterogeneous in regard to spermatogenesis status. The testis is considered heterogeneous when 5 testicular sites or less show the cytomorphological changes of the highest stage of spermatogenesis diagnosed in that particular patient.
Results: Patients' ages ranged from 20-55 years with average age 28.5 years. Testicular fine needle aspiration from the 10 sites from each patients showed that the testis was homogenous in 1083 cases (67%) and heterogeneous in 537 cases (33%). The heterogeneity occurred in stage II-VI as follows: Stage II: form 56 cases (out of 537) (10% of heterogeneous cases); Stage III: 54 cases (10%); Stage IV: 55 cases (10%); Stage V: patients with Hypospermatogenesis form 68.5 % of heterogeneous cases and distributed as follows: Very marked Hypospermatogenesis: 43% of heterogeneous cases; Marked Hypospermatogenesis 14%; Moderate Hypospermatogenesis 9.5%, Mild Hypospermatogenesis 2%. Stage VI: form 1.5% of the heterogeneous cases.
Conclusions: Testis is a heterogeneous organ in regard to sperm production in infertile men in about 1/3 of the cases. The lesser amount of sperms produced, the more likely that the testis will be heterogeneous. It is essential to sample the testis from multiple sites to search for sperm production. This fact is important for sampling the testis in infertile men entering assisted reproduction program.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 93, Wednesday Afternoon