Editing Infertility: Diagnosis and Evaluation (section)

== Testicular biopsy ==
* '''<span style="color:#ff0000">Should not routinely be performed to differentiate between obstructive azoospermia and non-obstructive azoospermia</span>[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
**'''Differentiation of obstructive azoospermia from non-obstructive azoospermia may most frequently be predicted from clinical and laboratory results without the need for surgical diagnostic biopsy.''' 
***'''FSH > 7.6 IU/L and testis longitudinal axis < 4.6 cm indicate an 89% likelihood of spermatogenic dysfunction as the etiology'''
***'''FSH < 7.6 IU/L and testis longitudinal axes > 4.6 cm indicate 96% likelihood of obstruction as the etiology'''
**'''In the infrequent cases with intermediate values, testis biopsy may be performed''' 
***'''Consider diagnostic and therapeutic biopsy if FSH and testicular volume normal but no clinical evidence of obstruction'''
****May identify germ cell maturation arrest
***In the rare cases where testis biopsy is done primarily for diagnostic purposes, sperm cryopreservation from the sample should be attempted if ART is an option.
* Spermatogenesis may be highly focal in men with azoospermia so a random biopsy may miss areas of sperm production