It is known that in 40% of couples with fertility problems, the male counterpart is the one who originates the problem. Amongst the general causes of male infertility, semen quality and ejaculation problems are the most important ones. Unlike women, hormonal problems in men are less frequent and if there is any, they tend to point an anomaly in sperm production.
That is why the first test to be carried out in men is the sperm analysis, so if sperm is altered, the specialist can ask for supplementary tests, like the testicular biopsy.
Testicular biopsy is indicated if a semen analysis shows some sperm alterations, or if no sperm is observed at all in the ejaculate (and previously ruling out retrograde ejaculation or obstruction of the ejaculatory ducts).
The two main indications to conduct a testicular biopsy are:
- Histological study: in case sperm concentration in the ejaculate is below the cut-off points (oligozoospermia) or in case of any sperm is observed in the ejaculate (azoospermia). In this study the testicular tissue is analyzed, checking its capacity to produce sperm.
- Cytogenetic study: to carry out if there is a history of recurrent miscarriages or low sperm motility (asthenozoospermia). With the cytogenetic study we can see the structure, composition and co-ordination of the chromosomes in every developmental stage. Any anomaly in these chromosomes can cause either infertility or recurrent miscarriages.
Goals of the testicular biopsy
This test encompasses a surgical intervention that will allow us to determine whether spermatogenesis in the testes is normal or not.
Therefore, and depending on the case, this technique will provide information about the existence of an obstructive pathology (if the duct which releases the sperm is blocked) or a secretory pathology. That refers to the absence of sperm production or sperm that has not achieved its complete growth.
In addition to the diagnostic side of this intervention, the testicular biopsy is used to collect sperm directly from the testicle when it is not present in the ejaculate. The objective sought with this aspect of the procedure is gathering sperm to be frozen. This frozen sperm will be used in fertility treatments, such as the intracytoplasmic sperm injection (ICSI), with the aim of achieving pregnancy.
Procedure of testicular biopsy
The surgical treatment operated in testicular biopsy is performed under local anesthesia. After the extraction of a small portion of the testicle, it is evaluated via microscopic examination in order to observe the presence of sperm.
The complete procedure lasts about 15 to 20 minutes, and it is a painless intervention (except the anesthesia is injected).
Despite the proper choice of the technique as the mean of assessment and its correct performance, there can be complications in a small percentage. These complications are generally minor and comprise bleeding, pain, inflammation, or infection of the wound that will require the adequate treatment.
An alternative to testicular biopsy is testicular puncture. The portion of tissue to be observed under the microscope is needle-extracted with no incision required.