Hum. Reprod. Advance Access originally published online on April 21, 2005
Human Reproduction 2005 20(8):2279-2288; doi:10.1093/humrep/dei027
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The safety of ultrasonically guided testis aspiration biopsies and efficacy of use to predict varicocelectomy outcome
1 Division of Urology, Robert Wood Johnson Medical School, Camden, New Jersey, 2 Fertility Research Laboratories, North Shore–Long Island Jewish Institute for Medical Research, Manhasset, New York, 3 Department of Obstetrics and Gynecology, North Shore University Hospital, North Shore–Long Island Jewish Health System, Manhasset, New York and 4 Departments of Obstetrics & Gynecology and Cell Biology, New York University School of Medicine, New York, USA
5 To whom correspondence should be addressed at: North Shore–Long Island Institute for Medical Research, 350 Community Drive, Room 125, Manhasset, NY 11030, USA. Email: sbenoff{at}nshs.edu
BACKGROUND: We hypothesized that infertile men with varicoceles have molecular/genetic defects that interact with varicoceles to induce infertility. Studies directly on testis tissue appeared to be a way to link histology, markers for molecular/genetic defects and spermatogenesis, but testis biopsies may induce morbidity. In this report, we present safety and efficacy data on ultrasonically guided, single stick, percutaneous aspiration. METHODS: Biopsies were performed on 115 infertile men with varicoceles and five men with obstructive azoospermia. Morbidity was examined by pre- and post-biopsy ultrasound, efficacy by ability of two markers to predict >50% increase in sperm density post-operatively. All patients had three pre- and three post-operative semen analyses. RESULTS: 78.3% of patients had no ultrasonic testicular defects immediately post-biopsy. By 2 months, 100% had no defects. Biopsy markers [testicular cadmium (<0.453 ng/mg tissue) and an intact calcium channel mRNA sequence] predicted >50% increase in sperm density with 82.9 and 90.5% accuracy, respectively. CONCLUSIONS: Ultrasonically controlled, percutaneous aspiration testis biopsies are safe. Specimens so acquired can assist study of molecular/genetic markers associated with spermatogenesis in infertile men with varicoceles. Tissue cadmium level, calcium channel sequence and other markers may predict outcome of varicocele surgery.
Key words: biopsy/percutaneous aspiration/testis/ultrasound/varicocele