Testicular biopsy may be done to assess an infertile male with azoospermia (total lack of sperm). Four main histologic patterns are seen (germ cell aplasia, spermatocytic arrest, generalized fibrosis, and normal spermatogenesis). The presence of normal spermatogenesis suggests obstructive azoospermia with an obstruction distal to testis (bilateral obstruction or absence of some portion of the duct system).
Criteria for tubular blockage in azoospermia:
(1) tubular diameter normal or slightly decreased
(2) all stages of spermatogenesis including mature sperm present
(3) the normal orderly arrangement in spermatogenesis is lost
(4) central lumen is absent
(5) findings #1-4 are seen in >= 50% of tubules
Similar findings are seen in some cases of hypoplasia, but only affect occasional tubules.
If azoospermia is present but only normal tubules or mild tubular lesions are seen, then exploratory surgery may be performed. Varicoceles may be ligated and divided with some success in removing obstruction. If motile sperm are seen in the epididymis, then an epididymovasostomy may be performed.
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