RESUMEN
To identify and categorize various pathological patterns seen in testicular biopsies of azoospermic males along with their Johnson’s score and to evaluate the importance of the histological examination of testicular biopsies for further clinical planning. Methods: The study was conducted in the Department of Pathology of Mahatma Gandhi Medical College and Hospital, Jaipur, India. Slides prepared from testicular biopsies either unilateral or bilateral (received between January 2003 to December 2012), of 135 patients who had azoospermia on routine semen analysis were retrospectively retrieved and reviewed. Various histopathological patterns were evaluated and categorized and were graded according to the Johnson’s scoring. If more than one histological pattern was noted in the same testicular biopsy it was called as ‘Mixed pattern’ whereas if the right and left testes showed different histological pattern it was called as ‘Discordant pattern’. Results: A total of 152 testicular biopsies were collected from 135 patients (118 patients with unilateral and 17 patients with bilateral testicular biopsies). All the patients had azoospermia on routine semen analysis. The age of the patients ranged from 20 to 51 years. The most common histological pattern observed was Normal spermatogenesis (35.56%) followed by Sertoli cell only syndrome (23.70%) and Germ cell maturation arrest (20%). Hypospermatogenesis and Seminiferous tubule hyalinization was seen only in 2.96% and 2.22% of the cases respectively. Conclusion: This study has shed some light on the possible underlying etiologies of primary male infertility and emphasizes the need for bilateral testicular biopsies and on meticulous pathological examination of all seminiferous tubules in order to identify mixed and discordant patterns. The data extrapolated from our study can serve as a template for better management of primary male infertility and will optimize the advanced therapeutic modalities for the infertile couples.