Pitfalls in the pathological diagnosis of male infertility

Infertile men should be investigated and managed in reproductive assistance centres supported by a complementary, specialized team who can apply advanced technology. Pitfalls in the clinical, laboratory, genetic and pathological diagnosis are highlighted in this article, along with suggestions to circumvent them. Objectivity is advocated, especially in pathological diagnosis. Diagnostic testicular fine needle aspiration with mapping is preferable to an open biopsy and should be performed by the pathologist; this is indicated in cases of Grade A2 (non-obstructive) azoospermia prior to sperm retrieval in the intra-cytoplasmic sperm injection cycle. Along with use of an objective classification system for azoospermia, this can guide sperm retrieval and largely avoid open tissue biopsies. Standardized pathological methods will support evidence-based data to achieve reproducible investigative and treatment results.