A testicular biopsy is a surgical procedure during which a small amount of tissue is removed from the testicles for microscopic examination. This procedure may be performed for a number of reasons: to help determine the cause of male infertility, to remove sperm to be used for assistive reproductive technology (ART), or to determine whether a testicular lump is malignant or benign. When a testicular biopsy is performed to assist in fertility, tissue containing sperm removed during the biopsy may be used for in vitro fertilization (IVF) or for sperm donation. When there is a question of malignancy, the surgeon's goal is to detect whether any cancerous tissue is present.
When the testicular biopsy is related to questions of infertility, the procedure may be performed either as a testicular sperm extraction (TSE), through an incision, or as a testicular sperm aspiration (TESA), through a needle. The test may also be performed to diagnose a low sperm count or azoospermia, a condition in which the man has no sperm in his semen. During a TSE, several areas in the testicle may be sampled because it is likely that there is a higher sperm count in some regions than in others.
The Testicular Biopsy Procedure
The way the procedure is performed depends, to a large extent, on its purpose. While a needle biopsy is normally performed in the doctor's office, if an open biopsy is required, the patient may be operated on in a surgical center or hospital. However the procedure is to be performed, the skin over the testicle is cleaned thoroughly with antiseptic and a local anesthetic is administered. For a needle biopsy, no incision is required. If a small incision is necessary, it will be sutured after the tissue sample is removed.
Recovery from a Testicular Biopsy
After a testicular biopsy, the scrotum may swell or discolor, but such symptoms usually resolve quickly. Patients are instructed to keep the area dry for several days and to refrain from using aspirin or other medications that may cause bleeding for about a week. Most patients are also advised to wear an athletic supporter for a few days, and to avoid sexual activity for a week or two.
Results of a Testicular Biopsy
If the biopsy has been performed to investigate fertility issues, it is possible that the procedure will show a low sperm count or hormone dysfunction. On the other hand, if the testicle appears to have normal sperm, but a semen analysis shows reduced sperm or no sperm at all, there may be a blockage preventing sperm to pass into the semen. If this is the problem, a surgical repair may be necessary.
If the testicular biopsy has been performed as a means of sperm retrieval, the extracted sperm may be used in one of several fertilization procedures, including in vitro fertilization, intrauterine insemination, or intracytoplasmic sperm injection.
If the testicular biopsy has been performed because a suspicious lump has been detected during a medical or self-examination, the extracted tissue will be examined carefully to determine whether a malignancy is present. If there is a malignancy, the entire affected testicle may have to be surgically removed.
Analysis of a testicular biopsy may also show a spermatocele or orchitis (testicular inflammation), either of which may require further medical attention.
Risks of a Testicular Biopsy
While there is a slight risk of bleeding or infection, this procedure is considered quite safe.