[Testicular biopsy in azoospermia before fertilization interventions--uni- or bilateral? Initial results of a...

Azoospermia can have testicular or posttesticular causes. For confirmation of the diagnosis, a testicular biopsy is recommended. Whether bilateral biopsy is necessary is the subject of some controversy. In a prospective study, 44 consecutive male patients (mean age 32.4 [20-52] years) with azoospermia were examined in our andrological department. Spermatogenesis was analyzed by means of a semi-thin technique and with reference to a modified Johnsen-Score. There was no difference in median size between the right (13.5 [8.5-15] ml) and the left testis (11 [7-15] ml). In the analysis of the score values, we found no differences between the two testes (median scores: right side 3 [2-7.2], left side 3.75 [2.1-7.45]). In one quarter of the patients who had a difference of more than 2 ml in testicular size the higher score was found in the smaller testis. In linear regression analysis, no correlation was found between differences in testicular volume and score differences. There was a qualitative difference in spermatogenesis in two patients. In no patient was a carcinoma in situ detected. The above results led us to the conclusion that a unilateral biopsy is adequate from both qualitative and quantitative aspects.