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Hum. Reprod. Advance Access published online on August 3, 2006
Human Reproduction, 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
Received May 8, 2006
Revised June 11, 2006
Accepted June 16, 2006

Article

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

R.I. McLachlan 1 *, E. Rajpert-De Meyts 2, C.E. Hoei-Hansen 2, D.M. de Kretser 3, and N.E. Skakkebaek 2

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

* To whom correspondence should be addressed.
R.I. McLachlan, E-mail: rob.mclachlan{at}princehenrys.org


  Abstract

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.

Keywords: male infertility/spermatogenesis/TESE/testis biopsy/testis cancer.
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