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While the biopsy is an easy test to perform, it is difficult to interpret properly, unless done by an expert. The doctor looks for evidence of sperm production in the seminiferous tubules. In some cases, there is no sperm production at all (absent spermatogenesis); or the sperm production is arrested at a particular stage (maturation arrest). This implies testicular failure, which is usually irreversible, and there is no treatment for this malady. If, on the other hand, sperm production in the testes is completely normal, and yet there are no sperm in the ejaculated semen, this clearly means that there is a block in the male reproductive tract. This is the one condition in which a testis biopsy is extremely useful (i.e., in the evaluation of the azoospermic male, to determine if there is a block to sperm transport).
A testis biopsy is often a procedure which is done badly because it is so "minor" so beware! It is preferable that the biopsy be done by a specialist; a poorly done biopsy may make reconstructive surgery on the epididymis more difficult later on, by causing adhesions and fibrosis (scarring). The commonest problem with the biopsy, however, is that the biopsy result is not reported accurately by the pathologist. Interpreting a testis biopsy is difficult and requires special expertise and is not something that the ordinary pathologist does well. You should retrieve and retain your own slides and preserve them carefully. The pathology laboratory can also be instructed to keep the tissue ("blocks") carefully. It is unfortunately common to find that a testis biopsy has to be repeated simply because the first one was done so badly that its results could not be accurately interpreted. It may also be a good idea to get a second specialist's opinion on the testis biopsy slides.
Vasography is another surgical test in which a radio- opaque dye is injected into the vas to determine if it is open, and, if blocked, to find out the exact site of the block. This test requires very delicate surgery and X-ray equipment and is a very infrequently done procedure because it can damage the vas.
For some men with testicular failure, a karyotype (study of the chromosomes) is useful, because it allows one to determine if a chromosomal problem (e.g., Klinefelter's syndrome, 47, XXY, with an extra X Chromosome) is responsible for the azoospermia. Some research clinics also offer testing for microdeletions on the Y-chromosome a newly discovered cause for testicular failure in about 15% of infertile men. While there is no treatment for this disorder, at least the test result provides an answer to the question of why the testes have failed a question which, unfortunately, medicine today still cannot answer, in the majority of patients.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
