La place actuelle de la biopsie testiculaire dans l’exploration de l’homme azoospermique

Resume

La biopsie testiculaire a connu des intérêts fluctuants. D’indispensable pour évaluer une situation andrologique, son apport a été jugé inutile dès que des dosages plus précis de la F.S.H. étaient disponibles.

Elle a connu un renouveau comme évaluation préopératoire d’une intervention microchirurgicale andrologique mais, comme cette chirurgie est actuellement souvent abandonée au profit de la T.E.S.E., l’intérêt de la biopsie s’est concrétisé en une simple question: “y a-t-il encore présence de quelques spermatozoïdes?” Dès lors, le caractère diagnostique de la biopsie s’est modifié en geste thérapeutique.

Abstract

The interest for testicular biopsy has been severely fluctuating during the development of andrological investigation and treatment.

In the fifties and sixties much energy was spend on reading spermatogenesis very accurately and most protocols from that period focussed on the levels at which a stop in spermatogenesis could be observed. This work led to several scores that proved however to have no practical therapeutic value.

When F.S.H. could be more accurately measured by R.I.A., the interest for biopsy faded severely. It was only rekindled by the andrological microsurgeons but when in its turn this therapeutic approach lost much of its interest by the T.E.S.E. method, also this aspect of the biopsy lost its value.

At the present time, most clinicians dealing with the use of testicular spermatozoa in Assisted Fertilisation Programs, are only interested in knowing whether or not some mature spermatozoa are still present. It was clarified that even in very severely damaged testes a few tubules can still contain a limited amount of spermatozoa.