Testicular Biopsy for Male Infertility

Did you know male-factor infertility affects 50% of all infertility cases? When a couple is unable to get pregnant naturally after having unprotected sexual intercourse for a year or longer, they opt for fertility tests to identify the cause. For male-factor infertility, semen analysis, imaging, and hormone tests are used to get an accurate diagnosis. If they don’t give a reliable result, a testicular biopsy can be scheduled. It provides a comprehensive report about the man’s sperm production. In this post, we’ll walk you through the details of testicular biopsy for male infertility, when it’s needed, how it’s done, and the risks. Read on.

Diagnose Testicular Biopsy

Testicular biopsy is a minimally invasive diagnostic procedure that involves extracting testicular tissues and examining them in a lab to check for the presence of blockage, infection, or cancer. It’s not used as a primary diagnostic tool, though. 

When you see a fertility specialist, they will most likely recommend semen analysis (which shows the sperm count, semen volume, sperm motility, and overall quality). They might run blood tests to know if your hormones are out of balance. If none of these tests generate conclusive results, a testicular biopsy could be your last resort.

Why is Testicular Biopsy Done?

Here’s when a testicular biopsy is needed:

Diagnosing Azoospermia

Low or no sperm in your semen sample implies azoospermia, a condition that affects 10% of all infertile men. Azoospermia can be obstructive, in which a blockage in your reproductive tract can prevent sperm from releasing through the ejaculate. Or, it can be non-obstructive, which suggests your testes do not produce sperm. The latter could occur from a genetic condition, a vasectomy, or hormonal imbalance. Biopsy clarifies whether it’s obstructive or non-obstructive azoospermia.

Diagnosing Other Testicular Issues 

Issues with sperm production or transport can occur due to underlying conditions like varicocele veins, testicular torsion, or cancer. Varicocele, or enlarged veins in your scrotum, is one of the most common causes of male-factor infertility. A biopsy can identify varicocele and evaluate sperm production in men with this condition. Testicular cancer can be another possible cause of male-factor infertility, as a growing tumor can interfere with sperm production. A testicular biopsy can rule out malignancy, varicocele, and other medical issues.

Sperm Retrieval for IVF

Testicular biopsy can be used to extract sperm from the testicular tissues. It works for men with little to no sperm in the ejaculate. The procedure harvests sperm directly from the testes. This can be used for Intracytoplasmic Sperm Injection (ICSI) — injecting a single sperm into the egg to increase chances of fertilization. If sperm can’t be obtained through masturbation, a testicular biopsy is your best bet.

Procedure Types

It’s a minimally invasive surgery performed in an outpatient setting. Let’s explore the methods used for conducting testicular biopsy:

Percutaneous Biopsy

Percutaneous or needle biopsy is done under local anesthesia and is used to extract sample tissue from your testicles through a fine needle. Here’s a look at the step-by-step procedure:

1. Your doctor will clean and sterilize the scrotum
2. They will use local anesthesia to numb the area
3. A thin needle is inserted through your scrotum to collect tissue samples from the testes
4. The sample is sent to the lab for microscopic testing.

The procedure involves no incision or sutures, making it a less invasive option. You can expect a quick recovery.

Open Biopsy

The above technique may not be viable for every patient. If a needle biopsy proves insufficient or your doctor suspects an underlying issue that may need a more thorough evaluation, an open biopsy can be conducted. Here’s how it’s executed:

1. You will be given general anesthesia 
2. A small cut is made on the scrotum to harvest testicular tissues 
3. The doctor will close the incision with stitches.

An open biopsy gives a clear view of the testicles and can detect abnormalities, which may impair your testis’s function and its ability to produce sperm.

Risks 

Contrary to what people believe, testicular biopsy doesn’t cause an inability to get or keep an erection, nor does it affect ejaculation. However, like any invasive medical procedure, it carries certain risks. 

Infection: Although rare, post-surgical infection can occur after testicular biopsy. Your doctor will sterilize the scrotum to minimize the risk of infection. 

Bleeding: Surgical procedures carry a small risk of bleeding, which occurs when a blood vessel is damaged. 

Damage to Your Testicles: The procedure rarely damages your testicular tissues, but it’s a possible complication. It can impair your sperm production.

In addition to these, testicular biopsy could simply fail. If your semen doesn’t have any sperm at all, your doctors might not be able to retrieve sperm through biopsy. To mitigate the risk of infection and other complications from testicular biopsy, it’s advisable to see a fertility specialist. Get it done by an experienced and board-certified surgeon.

Post-Procedure Care

Recovery after testicular biopsy can take a few days or weeks, depending on the technique used. Your doctor will give detailed post-recovery instructions to speed up your healing. Here are a few essential tips that may help:

• Use ice packs to minimize swelling
• Avoid physical activity for the first few days or until your testicles heal
• Do not engage in sexual activity until your doctor clears you for it
• Keep the surgical site dry
• Do not wash the area for at least 48 hours 

Some side effects, like discoloration, swelling, and minor bleeding from the surgical site, are normal. See your doctor immediately if you experience heavy bleeding, severe pain that doesn’t get better with painkillers, excessive swelling in the scrotum, and fever.

Conclusion

Testicular biopsy is a highly reliable diagnostic tool for male-factor infertility. It identifies the underlying causes of infertility, such as varicocele, low or no sperm production, obstructive and non-obstructive azoospermia, testicular cancer, torsion, and so on. 

It’s comparatively more invasive and requires a longer recovery than semen analysis and other non-invasive tests. Consult a fertility specialist and weigh the risks and benefits of the procedure before considering it.