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Hum. Reprod. Advance Access published online on April 21, 2005
Human Reproduction, doi:10.1093/humrep/dei027
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© The Author 2005. 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@oupjournals.org
Received November 24, 2004
Revised February 10, 2005
Accepted March 17, 2005

Article

The safety of ultrasonically guided testis aspiration biopsies and efficacy of use to predict varicocelectomy outcome

Joel L. Marmar 1 and Susan Benoff 2*

1 Division of Urology, Robert Wood Johnson Medical School, Camden, New Jersey, USA,
2 Fertility Research Laboratories, North Shore-Long Island Jewish Institute for Medical Research, Manhasset, New York, USA, 3Department of Obstetrics and Gynecology, North Shore University Hospital, North Shore-Long Island Jewish Health System, Manhasset, New York, USA and 4Departments of Obstetrics & Gynecology and Cell Biology, New York University School of Medicine, New York, USA

* To whom correspondence should be addressed.
Susan Benoff, E-mail: sbenoff{at}nshs.edu


  Abstract

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.

Keywords: biopsy; percutaneous aspiration; testis; ultrasound; varicocele.
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