Testicular biopsy

* Testicular Biopsy Dr Amal Altaher *Definition: It’s a small piece of testicular tissue is surgically removed to retrieve spermatozoa from testis before IVF. The extracted sperm can be freeze and stored. *Indication of testicular biopsy: 1-Evaluat infertility and asc...

* Testicular Biopsy Dr Amal Altaher *Definition: It’s a small piece of testicular tissue is surgically removed to retrieve spermatozoa from testis before IVF. The extracted sperm can be freeze and stored. *Indication of testicular biopsy: 1-Evaluat infertility and ascertain status of spermatogenesis in unexplained infertility. 2-Incresed FSH 3 time than normal is sufficient evidence of primary hypogonadism to obviate need for biopsy. 3-If clinical finding are pathogenomic for obstruction- testicular failure. 4- Biopsy is not required to establish cause of azoospermia. *Types: Diagnostic TB: diagnostic procedure employed to ascertain cause of azoospermia to role out neoplastia and assessment disruption in spermatogenesis. Therapeutic TB: this procedure focused on extracting sperm from more extensive portion of testicular tissue for reproductive application *Factors affecting surgical sperm retrieval: 1-Age 2-Testicular volume 3-Reproductive hormone level 4-Preoperative DTB Complications: 1-Risk of bleeding and infection. 2-Sorness of biopsy area 2-3 days after biopsy. 3- Swelling of scrotum. *Technique: 1-Open surgical incisional biopsy. 2-Percutaneouse testis biopsy. 3-Percutaneouse testis aspiration. Procedure: Simple and inexpensive under local or general anasthesia Macrosurgical (convential) microsurgical(TESE) by help of operative microscope to see the seminiferous tubule if large taken and chance to get sperms increased Types of biopsy: open biopsy :via surgical incision in scrotum percutaneous : via needle aspiration An adequate testicular biopsy for infertility size 3mm contain 3-5 lobules, 9-20 seminiferous tubules with intervening septa * Processing of biopsy: Diagnostic biopsy using Bouins fluid Zenker/Stieves fluid, formalin not used because it shrinkage of tubules. Therapeutic biopsy delivered to spermatology lab and mechanically or enzymatically minced. * This article study relation of inflamatory marker and SRR in NOA and reproductive outcome. * NOA associated with medical condition such as varicocel, hypogonadism ,chronic diseases. * Oxidative stress from this inflammatory process which associated with DNA and membrane damage lead to azospermia. * 20% of azospermia biopsy shows immune cell infiltration and impact of systemic inflammationon SRR in NOA * By using inflammatory marker NLR-PLR-MER which associated with linked with chronic diseases and explore connection between SRR and reproductive outcome. * The study found common preoperatve variable as age, hormonal level, inflammatory biomarker not reliable predict sucessful sperm retrival in NOA