BACKGROUND Infertility is an ever-increasing problem in today's world. It can be due to male or female causes. Azoospermia seen in 5-10% of infertile men is due to obstructive or non-obstructive causes. Traditionally, testicular biopsy is the gold standard for evaluation. Fine-needle aspiration (FNA), however, is minimally invasive, provides qualitative and quantitative information about spermatogenesis, and can aid in assisted reproductive techniques making it a novel technique for the evaluation of male infertility. OBJECTIVE We aimed to classify different causes of azoospermia into different patterns based upon FNA, and assess the utility of cell indices in classifying cases into different patterns. METHOD We conducted a prospective and a retrospective study of 42 azoospermic males, confirmed on semen analysis, over a period of 5 years. Patients were subjected to FNA of the testes. Smears were prepared, air-dried, wet-fixed, and then stained with May-Grünwald Giemsa and Papanicolaou stains, respectively. Cells were identified using predetermined morphologic criteria, and various indices were calculated followed by statistical analysis of the observations. RESULTS The mean age of 40 patients who satisfied the adequacy criteria was 32.75 years (range 22-48 years). Thirty-four patients had primary infertility and 6 had secondary infertility. Of these, 12 had normal spermatogenesis, 8 had hypo-spermatogenesis, 3 had early and 7 had late maturation arrest, 6 had Sertoli cell-only syndrome (SCOS), and there were different results in each testicle in 4 cases. The Sperm Index (SI) was significantly higher in all cases of normal spermatogenesis than in any of the hypo-spermatogenesis cases (p = 0.009). The Sertoli Index (SEI) in cases of hypo-spermatogenesis and maturation arrest was significantly higher than in cases of normal spermatogenesis (p < 0.001). The Sperm-Sertoli Index (SSI) also showed significant differences between cases of hypo-spermatogenesis and normal spermatogenesis (p < 0.001). These indices were useful in categorising patients with azoospermia. CONCLUSION FNA helps to easily and accurately identify all types of testicular cells without biopsy. SI, SEI, and SSI are powerful cell indices for assessing the extent of spermatogenesis and classifying various causes of azoospermia. Bilateral sampling and multiple aspirations give a better mapping of spermatogenesis within the testes. Testicular FNA can thus play a very important role in the evaluation of male infertility.

中文翻译：

---

无精子分类的睾丸细针穿刺细胞学及其在男性不育评估中的价值。

背景技术不育症是当今世界上日益严重的问题。这可能是由于男性或女性原因。在5-10％的不育男性中发现无精症是由于阻塞性或非阻塞性原因引起的。传统上，睾丸活检是评估的金标准。然而，细针穿刺术（FNA）具有微创性，可提供有关精子发生的定性和定量信息，并可协助辅助生殖技术，使其成为评估男性不育症的新技术。目的我们旨在基于FNA将无精子症的不同原因分为不同的模式，并评估细胞指数在将病例分类为不同模式中的效用。方法我们在5年内对42例无精子症男性进行了前瞻性和回顾性研究，经精液分析确认。患者接受睾丸的FNA检查。准备涂片，风干，湿固，然后分别用May-GrünwaldGiemsa和Papanicolaou染色。使用预定的形态学标准鉴定细胞，并计算各种指标，然后对观察结果进行统计分析。结果满足适当标准的40例患者的平均年龄为32.75岁（范围22-48岁）。34例原发性不孕，6例继发性不孕。其中12例具有正常的精子发生，8例具有低精子发生，3例具有早期成熟阻滞和7例具有晚期成熟停止，6例具有Sertoli cell-only only syndrome（SCOS），每例睾丸有4例不同的结果。在所有正常精子发生病例中，精子指数（SI）均显着高于所有低精子发生病例（p = 0.009）。精子发生不足和成熟停止的情况下的Sertoli指数（SEI）显着高于正常精子发生的情况（p <0.001）。精子-睾丸指数（SSI）也显示出精子生成低下和正常精子生成之间的显着差异（p <0.001）。这些指数可用于对无精症患者进行分类。结论FNA无需活检即可轻松，准确地鉴定所有类型的睾丸细胞。SI，SEI和SSI是评估精子发生程度和对无精子症各种原因进行分类的强大细胞指数。双边采样和多次抽吸可更好地绘制睾丸内精子发生的图谱。