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Hum. Reprod. Advance Access originally published online on August 3, 2006
Human Reproduction 2007 22(1):2-16; doi:10.1093/humrep/del279
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Histological evaluation of the human testis—approaches to optimizing the clinical value of the assessment: Mini Review

R.I. McLachlan1,2,3,5, E. Rajpert-De Meyts3, C.E. Hoei-Hansen3, D.M. de Kretser2,4 and N.E. Skakkebaek3

1 Prince Henry’s Institute 2 Andrology Australia, Monash University, Monash Medical Centre, Clayton, Australia 3 University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark and 4 Monash Institute of Medical Research, Monash University, Monash Medical Centre, Clayton, Australia

5 To whom correspondence should be addressed at: Prince Henry’s Institute, PO Box 5152, Clayton, Victoria, 3168, Australia. E-mail: rob.mclachlan{at}princehenrys.org

Testicular biopsy is a crucial assessment in reproductive practice with diagnostic and prognostic importance for assisted reproductive technologies (ARTs) and risk of testicular neoplasia. Endocrine and genetic tests cannot reliably distinguish obstructive azoospermia (OA) from non-obstructive azoospermia (NOA) or predict recovery of mature spermatids by testicular sperm extraction (TESE). Currently, divergent histological reporting systems and the use of imprecise terminology seriously degrade the value of the literature on TESE recovery rates and hamper evaluation of treatments and research on genotype–phenotype relationships. The rising incidence of testis cancer and carcinoma in situ (CIS), especially in infertile populations, requires that every effort be made for its early detection. We provide a systematic approach to the histological classification of spermatogenic disorders and detection of CIS in adult patients. We evaluate a large consecutive series of bilateral biopsies from infertile men and report (i) the frequency of bilateral or discordant patterns that supports the use of bilateral biopsy for comprehensive evaluation and (ii) a high prevalence of mixed patterns, particularly within the hypospermatogenesis classification, that helps account for reported success of TESE. We propose a new diagnosis code for testicular biopsies that addresses the needs of ART clinicians and allows data storage and retrieval of value in clinical practice and research.

Key words: male infertility/spermatogenesis/TESE/testis biopsy/testis cancer


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