Needling Infertility: Diagnostic Utility of Fine Needle Aspiration Cytology (FNAC) of Testes in the Evaluation of Male Infertility

Introduction: Male infertility affects nearly 15% of reproductive-age couples, with male factors contributing to about 50% of cases. Azoospermia, seen in 10–15% of infertile men, requires differentiation into obstructive and non-obstructive types. While a testicular biopsy is definitive, it is invasive. Fine Needle Aspiration Cytology (FNAC) offers a minimally invasive, cost-effective alternative for assessing spermatogenesis. Aim & Objectives: This study aimed to evaluate the diagnostic role of testicular FNAC in infertile males by classifying cytological patterns, correlating findings with semen analysis and hormonal profiles, and distinguishing obstructive from non-obstructive infertility. Material & Methods: A 12-month prospective study was conducted at GSVM Medical College and LLR Hospitals, Kanpur, including 140 infertile males with azoospermia or severe oligospermia (<5 million/mL). All underwent semen analysis (WHO criteria), hormonal assays (FSH, LH, testosterone, prolactin), and scrotal ultrasonography. FNAC was performed using a 23–25G needle. Smears were stained with May-Grünwald-Giemsa, Papanicolaou, and H&E, and categorized into five groups: normal spermatogenesis, hypospermatogenesis, maturation arrest, Sertoli cell-only syndrome, and testicular atrophy. Results: Among the 140 patients evaluated, normal spermatogenesis was observed in 29.3% of cases, all presenting with azoospermia and normal FSH levels, suggesting obstructive azoospermia. Hypospermatogenesis was also identified in 29.3% of patients and was commonly associated with borderline elevated FSH levels and oligospermia. Maturation arrest was the most frequent finding, seen in 35% of cases, predominantly in early stages, and correlated with elevated FSH and low testosterone levels. Sertoli cell-only syndrome was diagnosed with 0.7% of patients, all of whom had markedly elevated FSH levels and azoospermia. Testicular atrophy was observed in 5% of cases, indicating advanced testicular failure. Conclusion: FNAC is a safe, effective first-line diagnostic tool for evaluating male infertility, enabling accurate classification and guiding appropriate management, especially in resource-limited settings.