Comparison of testicular histopathology in patients with obstructive azoospermia and men with normal semen analysis

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To compare the testicular histopathology of patients with obstructive azoospermia due to different etiologies at different levels of obstruction with the testicular histology of normozoospermic men.

Materials and methods

This retrospective study involves reevaluation of testicular biopsy slides and data files of 137 patients with obstructive azoospermia and a comparison with testicular biopsy slides from 24 normozoospermic individuals who underwent emergency needle biopsy to rescue their intracytoplasmic sperm injection cycle. Obstructive azoospermia patients were subdivided according to the etiology of obstruction into two groups, congenital and acquired, and according to the level of obstruction into three categories: intratesticular, epididymal, and high obstruction. Both quantitative and qualitative evaluations were performed.


Interstitial fibrosis was significantly higher in the obstructive patients compared with the control group (P=0.004). The mean late spermatid score was found to be significantly lower in acquired obstruction compared with the control group (P=0.028). Comparison of acquired with congenital obstruction revealed more thickening of basement membrane and interstitial fibrosis in the acquired obstruction group, whereas the Johnsen score was found to be higher in the congenital obstruction group. When levels of obstruction were compared, nonsignificant differences were found with respect to histopathological features, late spermatid score, and Johnsen score. However, the percentage of interstitial fibrosis was significantly higher in the obstructive patients on comparing each level of obstruction with the control group. The level of significance increases as the site of obstruction approaches the testis.


Acquired obstruction of the genital tract is associated with altered testicular architecture and spermatogenic damage.

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