Role of Fine Needle Aspiration Cytology (FNAC) for Assessing Spermatogenesis in Patients with Azoospermia

Abstract

Background: Recent advances of In vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) combined with the progress in sperm retrieval from testis have provided a hope for azoospermic patients to become fathers. Objective: The aim of this study was to describe the cytological features of the cells aspirated from testes of patients with azoospermia and to select those who have mature spermatozoa in their aspirate for assisted fertilization. Methods: This was a prospective cross-sectional observational study conducted in Popular Diagnostic Center, Dhanmondi, Dhaka during May 2020 to September 2023. Under local anesthesia Fine Needle Aspiration Cytology (FNAC) was performed on 293 patients whose sperm count was zero in at least three consecutive semen samples. The collected data were analyzed using Statistical Package for Social Sciences (SPSS), version-23.0. The size of the testes was measured and recorded for each case. The cytological features of the aspirated cells were described and the patients who have mature spermatozoa were identified for assisted fertilization. Results: A total of 293 patients with confirmed azoospermia aged above 18 years and male gender were enrolled in this study. The most frequent age group of the patients was (46-60) years which includes 210(71.67%) of the patients. The mean age of the patients was 38.59±3.39 years. The most frequent risk factors of infertility were observed to be nil significant 219(74.47%). According to FNAC findings, the most frequent cytological type of spermatogenesis was observed to be complete maturation arrest at primary spermatocyte in 115(39.24%) patients of azoospermia followed normal spermatogenesis in 68(23.20%) patients, complete maturation arrest at secondary spermatocyte in 46(15.69%) patients and atrophic testis in 29(9.89%) patients. Conclusion: This study investigated that FNAC 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.