Testicular Biposy

A testicular biopsy is a test to remove a small sample of tissue from one or both testicles and examine it under a microscope to evaluate a man’s ability to father a child.

The testicles testes are oval-shaped glands that hang in the scrotum beneath the base of the penis. The testicles produce sperm (necessary for reproduction) and male hormones, such as testosterone.

Why It Is Done

A testicular biopsy may, on rare occasions, be done to help determine the cause of male infertility. Testicular biopsy may be done if both of the following are present:

  • The man’s semen does not have sperm.
  • Hormone test results are within the normal range.

Testicular biopsy is not usually used to detect testicular cancer. When cancer is suspected, an open surgical procedure (orchiectomy) is done to confirm the diagnosis. Testicular biopsy may also be done to retrieve sperm for in vitro fertilization for intracytoplasmic sperm injection (IVF-ICSI).

Surgical Sperm Extraction Freezing:

Surgical sperm retrieval may be a treatment option for men with:

  • An obstruction preventing sperm release, due to injury or infection
  • Congenital absence of the vas deferens (men born without the tube that drains the sperm from the testicle)
  • Vasectomy
  • Non-obstructive azoospermia – the testicles are producing such low numbers of sperm that they don’t reach the vas

In the first three conditions, sperm are produced by the testes, but are unable to be ejaculated because of the blockage or absence of the vas. The man can still ejaculate seminal fluid but this fluid will not contain any sperm. It is possible to collect sperm directly from the epididymis.

Occasionally it may be possible to surgically unblock the tube that carries the sperm during the ejaculation process, although this has a low success rate. In cases of vasectomy surgical correction in the form of vasectomy reversal may offer another treatment to this problem.

In cases of non-obstructive azoospermia (complete absence of sperm) very small amounts of sperm may be produced and can be collected directly from the testes. This is done by performing multiple testicular biopsies at random. In these cases a biopsy will normally be sent to the laboratory for analysis as to the possible cause of the problem. In men with obstructive azoospermia there is a very high chance of recovering sperm by this method (>90%). In men with non-obstructive azoospermia the chances of recovering sperm is approximately 40%.

Techniques

  • PESA (Percutaneous epididymal sperm aspiration) is the collection of sperm through a fine needle directly from the epididymis, where sperm is stored, after it is formed in the testes.
  • TESE (Testicular sperm extraction) is the collection of sperm from a biopsy or several biopsies from the testicular tissue after making a small incision in the scrotal skin.
  • TESA – Testicular sperm aspiration

TESA, or testicular sperm aspiration (also known as TESE, or testicular sperm extraction) is one of the surgical sperm harvesting techniques used for retrieving sperm in patients with azoospermia. A number of surgical sperm retrieval or recovery methods have been devised to recover sperm from the male reproductive tract.

This method is as effective as microsurgery to retrieve epididymal sperm, is much easier for both the patient and the doctor, and much cheaper as well, since the infertility specialist can do it himself. It is also much less traumatic, since there is no need to cut the scrotum, with the result that there is no scar at all.

For patients with obstructive azoopsermia in whom sperm cannot be found in the epididymis, it is always possible to find sperm in the testis. The easiest way to retrieve this is through TESA or testicular sperm aspiration, in which the testicular tissue is sucked out through a fine needle, under local anaesthesia. The testicular tissue is placed in culture media and sent to the lab, where it is processed. The sperm are liberated from within the seminiferous tubules (where they are produced) and are then dissected free from the surrounding testicular tissue.

There are 2 options for doing a TESA – diagnostic, or therapeutic. In a diagnostic TESE, the surgeon performs multiple diagnostic biopsies to determine if sperm are being produced in the testes or not. If no sperm are found, the diagnosis of complete testicular failure is confirmed, and treatment options then include adoption or donor insemination, since there is no treatment at present for this condition. If sperm are found, then these testicular sperm can be cryopreserved, and used for ICSI treatment in the future.