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Imranz clinic Rawalpindi
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The interpretation
While the biopsy is an easy test to perform, it is difficult to interpret proper
ly, 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 (ab
sent spermatogenesis); or the sperm production is arrested at a particular stage
(maturation arrest). This implies testicular failure, which is usually irreversi
ble, and there is no treatment for this malady. The key question is whether ther
e
is partial testicular failure; or whether the testicular failure is complete, wh
ich is why examining multiple areas of the testes is important. Men with complet
e
testicular failure have no sperm production at all in the entire testes. Men wit
h partial testicular failure will have a few areas of their testes which still
\produce sperm normally. These sperm can be used for TESE-ICSI treatment. Howeve
r, their testicular sperm production is so poor , that the testicular sperm do
not reach the ejaculate, as a result of which the sperm count is zero.
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 trac. This is called obstructive azoospermia, and is th
e one condition in which a testis biopsy is extremely useful (i.e., in the evalu
ation
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 b
iopsy,
however, is that the biopsy result is not reported accurately by the pathologist

. Interpreting a testis biopsy is difficult and requires special expertise and i

s not
something that the ordinary pathologist does well. You should retrieve and retai
n your own slides and preserve them carefully. The pathology laboratory can also
be
instructed to keep the tissue ("blocks") carefully. It is unfortunately common t
o 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 goo
d idea to get a second specialist's opinion on the testis biopsy slides.