Testicular Biopsy
Author : Professor Mahmoud Fawzy Ghaly
• Updated at: Jun 09, 2024 •
A testicular biopsy is a procedure that is done when after medication and treatment the male sperm count remained low (oligospermia) or zero (azoospermia), there was repetitive IVF failure, the sperm DNA fragmentation was high or motility and morphology where of such state that it was deemed better to take a sample from the source of sperm cell production.
What is a testicular biopsy?
A testicular biopsy means taking a small sample of testicle tissue for examination. This can be done for several purposes;
- Examination of suspicious tissue or textures in the testes.
- Extraction of sperm for In Vitro Fertilization (IVF) or Intra Cytoplasmic Sperm Injection (ICSI) if ejaculation semen shows bad quality or absent sperm cells.
Usually the tissue is obtained through a needle, but sometimes further examination or evaluation purposes require the surgeon to make small incisions in the testes and obtaining biopsies surgically. Both methods can be done under local or general anesthesia.
Uses of testicular biopsy
Testicular biopsy tissue can serve as a diagnostic and/or a tool of treatment.
If abnormal size, shape, firmness or consistency of the testicle arises suspicion of tumors, infection or immunological disorders affecting the testicles, a testicular biopsy examined under the microscope can give answers and treatments initiated accordingly.
If problems of infertility arise the biopsy taken can serve as treatment if spermatozoa are found in patients of azoospermia for IVF or ICSI purposes. Good quality spermatozoa taken directly from the testes can also be a solution for male infertility patients with bad sperm quality in terms of count, motility or morphology.
Types of testicular biopsy
1-Percutaneous Biopsy
A needle is inserted through the scrotal skin into the testicle and a sample taken. This procedure does not require an incision, it’s also referred to as a fine needle biopsy. The core needle biopsy is a variation in taking a percutaneous biopsy, the core sample has a larger diameter and takes a cylindrical piece of tissue. Your doctor will decide which is more suitable in your case.
2-Open surgical biopsy
Your surgeon starts by making a small incision and obtaining a sample of testicular tissue, stitches are used to close the incisions made.
Preparations before testicular biopsy
The preparations for a testicular biopsy depend on
- The reason a biopsy is taken. Your doctor will explain what the diagnosis or expected diagnosis is, the procedure, the possible outcomes and the treatment paths that can be taken according to the operative findings.
- Depending on the reason for the testicular biopsy procedure your anesthesiologist will decide whether anesthesia will be given locally or generally. In case of general anesthesia, the patient arrives fasting for at least 6 hours before the designated procedure time.
Recovery from testicular biopsy
Post operatively the patient will be advised to put ice bags intermittently on the scrotal area for a couple of hours to reduce pain and swelling, pain killers and antibiotics are prescribed if needed, and gauze should be changed daily until the wound heals which usually takes a couple of days.
Patient will be asked not to do heavy exercising for a couple of days and to keep the wound clean.
Success of testicular biopsy
A testicular biopsy is a minor procedure that does however need an experienced surgeon due to the high vascularity and male fertility that could be at stake if anything goes wrong.
The laboratory’s expertise is important in cases of infertility to find good quality sperm cells that can be used in IVF, ICSI or frozen for future usage.
In cases where a testicular biopsy is done for diagnostic reasons your doctor will guide you after pathology results are out.
Risks of a testicular biopsy
A testicular biopsy is a procedure with minor risks if in experienced hands some post-operative unpleasant experiences;
1- bleeding
2- Infections
3- Severe pain or swelling of the scrotum
4- If damage occurs to the testicles, testosterone levels and sperm cell numbers can decrease
5-fever or chills
