Testicular Biopsy

What is testicular biopsy ?

Testicular biopsy is a medical procedure in which a small sample of tissue is removed from one or both testicles to be examined under a microscope. The procedure is typically performed to help diagnose the cause of infertility, to evaluate abnormal testicular growths or tumors, or to investigate the cause of hormone imbalances.

When is a testicular biopsy performed for IVF or ICSI ?

Testicular biopsy may be performed in cases of male infertility when there is a problem with sperm production, such as low sperm count or azoospermia (no sperm in semen). In cases of azoospermia, a testicular biopsy may be performed to retrieve sperm directly from the testicle for use in assisted reproductive technologies such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

Testicular biopsy for IVF or ICSI is typically performed in cases where a man has no sperm in his ejaculate but has evidence of sperm production within the testicles. The retrieved sperm can then be used for fertilization in the laboratory.

In some cases, testicular biopsy may also be performed prior to cancer treatment, as chemotherapy and radiation can damage sperm production. The retrieved sperm can be frozen and used in the future for fertility preservation.

What are the genetic exams you have to perform prior to testicular biopsy for sperm extraction

There are several genetic tests that may be performed prior to testicular biopsy for sperm extraction. These tests can help assess the genetic health and fertility potential of the individual.

The most relevant genetic exams are:

• Karyotype analysis : This test examines the number and structure of chromosomes to detect chromosomal abnormalities such as Klinefelter syndrome (47,XXY) or other sex chromosome abnormalities ;
• Y chromosome microdeletion analysis : It evaluates the presence or absence of specific regions on the Y chromosome, which can be associated with impaired sperm production and infertility ;

It is important to consult with a healthcare professional or a fertility specialist who can determine which genetic tests are appropriate based on the individual’s specific circumstances and medical history.

How is a testicular biopsy performed ?

Testicular biopsy can be performed using two different methods : open biopsy or percutaneous biopsy.

Open biopsy involves making a small incision in the scrotum to expose the testicle. The surgeon then removes a small piece of testicular tissue for examination under a microscope. This method is typically used when a larger sample of tissue is needed or when multiple biopsies are required.

Percutaneous biopsy, also known as a needle biopsy, involves using a fine needle to remove a small sample of tissue from the testicle. This method is less invasive than open biopsy and can be performed on an outpatient basis using local anesthesia. It is typically used to obtain a smaller sample of tissue or when only one biopsy is needed.

During the biopsy procedure, the patient will lie on their back with their legs apart. The scrotum will be cleaned and a local anesthetic will be injected to numb the area. The surgeon will then make a small incision or insert the biopsy needle into the scrotum to remove a sample of tissue. The incision or puncture site will be closed with stitches or a sterile adhesive strip, and a bandage will be applied.

After the biopsy, the patient may experience some mild pain or discomfort in the scrotum for a few days. Ice packs and over-the-counter pain relievers can be used to alleviate any discomfort. The patient should avoid strenuous activity and sexual intercourse for a week or two after the procedure to allow the area to heal.

Cost of testicular biopsy

The cost of a testicular biopsy can vary depending on several factors such as the location, the type of biopsy performed, and the individual’s insurance coverage. In Tunisia, the cost of a testicular biopsy can range from $1,000 to $2,000 or more, depending on whether an open biopsy or percutaneous biopsy is performed.

It is important to note that some insurance companies may cover the cost of a testicular biopsy, especially if it is being done for medical reasons such as infertility. It is recommended that patients check with their insurance provider to determine their coverage and out-of-pocket costs. Additionally, some medical centers may offer financial assistance or payment plans for patients who cannot afford the full cost of the procedure.

Post-operative testicular biopsy

After a testicular biopsy, the patient will typically experience some degree of pain, swelling, and bruising in the scrotum.

It is important to follow post-operative care instructions provided by the surgeon, which may include :

• Resting and avoiding strenuous activity for several days after the procedure ;
• Using ice packs or cold compresses to help reduce swelling and pain ;
• Taking pain medication as prescribed by the doctor ;
• Wearing snug-fitting underwear or a jockstrap to provide support and reduce movement of the testicles ;
• Avoiding sexual activity and ejaculation for at least a week after the procedure ;
• Keeping the biopsy site clean and dry to prevent infection ;
• Checking the biopsy site regularly for signs of infection, such as redness, swelling, or pus ;

Most patients can return to normal activities within a week or two after the procedure, but it may take several weeks for the swelling and discomfort to completely subside. It is important to follow up with the doctor after the biopsy to discuss the results and any further treatment options that may be necessary.

Testicular biopsy result

The results of a testicular biopsy can provide valuable information about the cause of infertility, testicular growths or tumors, or hormone imbalances. The biopsy sample is typically examined under a microscope by a pathologist, who can identify abnormalities in the testicular tissue and provide a diagnosis.

If the biopsy is being performed to evaluate male infertility, the results will indicate the presence or absence of sperm in the testicular tissue. If sperm are present, they can be used for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) to help the couple achieve pregnancy. If sperm are not present, further testing may be needed to determine the cause of the infertility.

If the biopsy is being performed to evaluate a testicular growth or tumor, the results can help determine whether the growth is benign or malignant. Depending on the findings, further treatment may be recommended, such as surgery, chemotherapy, or radiation therapy.

In cases where a testicular biopsy is being performed to evaluate hormone imbalances, the results can provide information about the production and function of certain hormones in the testicles, which can help diagnose conditions such as hypogonadism or testicular failure.

It is important to discuss the biopsy results with the doctor to fully understand their implications and any recommended next steps.