Male infertility

Male infertility is a clinical diagnosis. It is pretty much the only reason for a testicular biopsy.

Male infertility
Diagnosis in short
Mixed pattern male infertility (Sertoli cells only mixed with hypospermatogensis). H&E stain.
LM	various patterns - see microscopic
LM DDx	intratubular germ cell neoplasia, germ cell tumour, inflammation of the testis
Site	testis, vas deferens and other sites
Prevalence	not very common
Prognosis	benign
Clin. DDx	(clinical diagnosis)
Treatment	dependent on underlying cause

This article focuses on the testicular causes of infertility. Testicular biopsy redirects to here.

General

• Infertility is a clinical diagnosis.

It can be divided into:

• Pre-testicular - e.g. hormonal, pituitary.
• Testicular.
• Post-testicular - e.g. blockage of vas deferens.

Microscopic

Male infertility on testicular biopsy shows one the following patterns:

1. Normal testis.
2. Hypospermatogensis.
3. Maturation arrest.
4. Sertoli cells only.
5. Seminiferous tubule hyalinization
6. A combination of the above.

DDx:

• Intratubular germ cell neoplasia.
• Germ cell tumour.
• Inflammation of the testis.

Sign out

• The diagnosis should be the pattern (#1-6 above).

The following should be commented on:

• The number of tubules.
• The number of tubules with sperm.
• Hyalinization of the tubules.
• Inflammation.
• Absence of intratubular germ cell neoplasia.

Mixed pattern

LEFT TESTIS, BIOPSY FOR SPERM RETRIEVAL:
- SERTOLI CELLS ONLY REGIONS (25% OF BIOPSY) INTERMEIXED WITH
  HISTOLOGICALLY NORMAL TESTIS (75% OF BIOPSY) WITH NORMAL NUMBERS
  OF SPERM.
- NEGATIVE FOR SIGNIFICANT SEMINIFEROUS TUBULE HYALINIZATION.
- NEGATIVE FOR SIGNIFICANT INFLAMMATION.
- NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA.

See also

• Testis.