A testicular biopsy is a test used to perform for male infertility, it is a procedure where a small sample of tissue is taken from the testes and examined under microscope for the presence of sperms and also to look for the cause of low sperm count and/or abnormal quality of sperms.
Which patients should undergo testicular biopsy?
In the evaluation of male infertility, the first step is to perform a semen analysis, if this test detects low sperm count, absent sperm count or an abnormality in the sperms then further testing is required in order to identify the cause of these abnormalities.
Next comes the blood testing for sex hormone levels and if the hormone levels come out normal then testicular biopsy should be performed as advised by the infertility specialists.
The testicular biopsy helps us assess the production and maturation of sperm cells in the testes.
Male reproductive system
We must first have a brief idea about the male reproductive system and the organs involved in formation and transport of sperms.
The male reproductive system consists of primary sex organs the testicles, scrotum and penis, and a few accessory organs.
Testicles are two oval shaped organs located outside the body in a pouch like sac of skin covering, called the scrotum. These are responsible for making the primary sex hormone, testosterone, and for generating sperms. Within the testicles are coiled tubes called seminiferous tubules which are responsible for producing sperms. The sperms pass from testicles to epididymis, where the sperms mature and are stored. They are released into the vas deferens by contractions, when sexual arousal occurs.
The vas deferens transports mature sperms into the urethra, the tube that is responsible for carrying urine and sperms outside the body, should ejaculation occur. The opening of urethra is at the tip of penis, and once a male reaches sexual climax, the semen which contains sperms is expelled from the penis.
Near the base of the bladder are sac like pouches called seminal vesicles, that are attached to the vas deferens, these seminal vesicles provide a sugar rich fluid (fructose) to the sperms, which is the source of energy that allows them to move.
The primary hormones responsible for the male reproductive system to function normally are Follicle-stimulating hormone, luteinizing hormone and testosterone.
For spermatogenesis (formation of sperms), the follicle stimulating hormone is necessary, and luteinizing hormone is required for stimulation of testosterone production, which in turn is required for sperm formation.
Uses of testicular biopsy:
- To determine if the problem of sperm production is caused by a blockage
- Extract sperms to use them in the IVF procedure, in instances where sperms are not present in the semen
- To diagnose testicular cancer
- To determine the cause of a testicular lump.
Process of testicular biopsy
There are two commonly used techniques to perform a testicular biopsy:
- Needle biopsy: this is performed under local anesthesia where a sample of testicular tissue is obtained using a specialized syringe or needle.
- Open biopsy: this can be performed under local or general anesthesia, here a small cut is made into the scrotal skin and a piece of testis is taken out using a blade.
Following are the details of commonly performed testicular biopsies:
A testicular biopsy is an out patient procedure, usually performed at your doctor’s clinic or a hospital. It takes 15 to 20 minutes. The patient is supposed to stay still during the procedure and hence is offered a sedative, some doctors prefer a general anesthesia.
The patient is asked to lie on his back and the scrotal area is cleaned to remove any bacteria. A local anesthesia is used to numb the skin of the scrotum.
Percutaneous biopsy: A percutaneous biopsy also called fine needle biopsy is a procedure where a thin needle is inserted into the scrotal skin. This needle has a syringe at its end which is used to collect the testicular tissue. This percutaneous procedure does not require any incision or stitches.
A variant of this fine needle biopsy is a Core needle biopsy where a hollow, spring-loaded needle is used to extract testicular cells sample called a core sample, the process of extraction makes a loud snapping sound and it is a larger sample as compared to the fine needle sample.
Open biopsy: An open biopsy is also called a surgical biopsy where your doctor starts by making a small 2 to 3 cm cut into your scrotal skin and the testes, then a small tissue sample is taken out for examination. The cuts are then stitched using absorbable sutures.
Complications of testicular biopsy:
The procedure of testicular biopsy is generally painless and risk-free, however in a few instances patients develop;
Prolonged bleeding from the site of biopsy.
Formation of a blood clot.
A mind swelling, pain and discoloration is normal. However, you should immediately call your doctor if any of the following occurs:
Severe bleeding that causes staining of large portions of your dressing.
Fever that is more than 100F.
Severe pain and swelling.
By- Dr. Alvina Arslan Meer
ART Coordinator (MBBS) and Online Counselor