A testicular biopsy is a male fertility test. The procedure is a form of mildly invasive surgery in which tissue is removed from the testicles and tested for the presence of active sperm cells. A testicular biopsy is usually not the first type of test recommended for suspected male factor infertility. The procedure is generally performed only after a semen analysis has shown that a man's ejaculate contains very few, or no, sperm cells.
Candidates For Testicular Biopsy
A man who is able to ejaculate, but who has a very low sperm count in his semen, may have a blockage in the tubes connecting the epididymis (where sperm cells are stored) to the ejaculatory duct which expels sperm cells when he climaxes. These tubes are called the vas deferens. Just because the sperm cells don't make it as far as the ejaculate doesn't mean, however, that they aren't being produced. This is exactly what a fertility doctor aims to find out by performing a testicular biopsy - whether or not a man's testicles are producing any sperm.
Types Of Biopsy
There is more than one type of testicular biopsy, the various biopsy procedures include:
- Needle biopsy - in which a needle is used to remove a tiny sample of testicular tissue.
- Biopsy with small scissors - in which, as the name suggest, a very small pair of scissors are used to cut out a small piece of tissue from the testicles
- Open biopsy - which is more invasive than the other two biopsy procedures mentioned above. A cut is made in the skin of the scrotum under general anesthetic, and tissue is removed. This procedure is usually reserved for patients in whom testicular cancer is suspected.
The first two procedures in the list are usually performed under local anesthetic. The patient may feel a sting as the needle administering the anesthetic goes in, but other than that he should not experience any pain.
A testicular biopsy procedure is usually performed on an outpatient basis, either by a surgeon or an urologist. It may take place at a doctor's office, in a day surgery clinic or in an operating room at a hospital.
The patient lies on his back while the specialist performing the biopsy sterilizes the scrotal skin and injects the local anesthetic. The surgeon then pushes a needle through the scrotum into the testicle and removes some tissue. He may need to repeat this process to take several samples.
If the surgeon is using scissors, he will make a very small cut in the scrotal skin and a very small cut in the testicle. He will then use the scissors to cut away a small amount of tissue. He then puts one stitch in each of the incisions, and the procedure is over.
Processing The Sample
The tissue will then be sent off to a laboratory where it will be examined under a microscope. If some active sperm cells are found, the patient's fertility doctor will have to consider the possibility that his patient's sperm ducts are obstructed in some way.
The biopsy procedure usually takes 15 to 20 minutes, and the patient goes home on the same day (unless he has had a general anesthetic). If severe swelling or pains in the testicles develop, or heavy bleeding occurs from the site of the biopsy, the patient should contact his doctor immediately. The likelihood of these complications, however, is extremely small.