How Testicular Biopsy helps determine cause of Infertility in Men

The two testicles are the prime male reproductive organs responsible for sperm and testosterone (male sex hormone) production. These testicles are present in the scrotum (the fleshy pouch of tissue) below the male genital organ.

Testicular biopsy has been the cornerstone of male infertility diagnosis since years in males with unexplained infertility and conditions like Azoospermia. Presently, testicular biopsies are usually followed for promoting sperm harvesting in males with non-obstructive Azoospermia, for use in intracytoplasmic sperm injection (ICSI)

A testicular biopsy is used to

• Analyze the location and condition of a lump in the testes.
• Determine the causes of infertility in males
• Extraction of sperm for performing In-vitro fertilization (IVF) procedure

What are the different types of Testicular Biopsies available ?

Testicular biopsy can be performed by two methods :

Percutaneous Biopsy : In Percutaneous Biopsy, also called ‘fine needle biopsy’, a thin biopsy needle with a syringe at the end is inserted. The syringe is used to gather the testicular tissues. The entire process is devoid of stitches or incisions.

A core needle biopsy varies from testicular biopsy since it uses a hollow and spring loaded needle to extract cells. The specimen obtained from core needle biopsy is larger than that of a fine needle biopsy.

Open Biopsy : An open biopsy, also called ‘surgical biopsy’, is initiated by making a small cut in the skin and in the testicle. Next, a small tissue sample is retrieved from the opening. This is followed by stitches to fix the cuts.

What is the clinical process of a Testicular Biopsy procedure ?

A testicular biopsy is mostly an outpatient procedure which takes not more than 15-20 minutes. The patient might be administered with local anesthesia

If you are having an open biopsy, the procedure will include the following steps :

• A small incision will be made through the skin.
• A pea-sized amount of testicular tissue will be aspirated.
• When the biopsy is taken, you may feel a little discomfort but not pain.
• Stitch removal is usually not required.
• The same method will be implemented on the second testicle.

What is the clinical process of a Percutaneous Biopsy

If you require a Percutaneous biopsy, the procedure will be as follows :

• The procedure for a Percutaneous biopsy depends upon the type of needle used, a core needle or a fine needle.
• A needle will be inserted through the skin of the testicle, in both cases.
• If you undergo a core needle biopsy, you will hear a loud clicking sound which indicates that the tissue sample has been taken.
• In case of a fine needle biopsy, the tissue sample will be withdrawn through a syringe.

How to ensure a safe and quick recover post Testicular Biopsy ?

There are a few points mentioned below that will help you heal faster :

• Avoid sexual activity for at least 1-2 weeks.
• Wear athletic supporter for the advised duration.
• Keep the site of biopsy dry (no contact with water.

What are the possible risks of a Testicular Biopsy

The most common and potentially several risks in a testicular biopsy is prolonged bleeding and post procedure infection. However, if you experience any of the following symptoms then consult your doctor immediately :

• Heavy bleeding at the site of biopsy
• hematoma (collection of blood)
• Unbearable pain or swelling of the scrotum
• Fever or chills

How to interpret the results of testicular biopsy ?

Once your tissue sample has been achieved, it will be investigated under a microscope. The pathologist will detect the defects in sperm quality or quantity. If you have a history of low or NIL sperm count, this might be due to obstruction leading to infertility. Blockages in the vas deferens can be a possible factor responsible for this type of infertility. A surgery may help treat this issue. If there is no blockage then it might have occurred due to absence of sperms

Additional causes of abnormal results comprises of :

• Spermatocele : a fluid-filled cyst located on the ducts of the testicles
• Orchitis : Swelling of the testicles due to infection
• Testicular cancer

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