What is a Testicular Biopsy?

Testicular biopsy is a procedure that involves taking a tiny piece of testicle tissue for examination under a microscope. The biopsy is performed by making a small incision in the skin of the scrotum, the layers beneath and the outer layer of the testicle. A small piece of the testicular tissue is then removed.

What is a testicular biopsy for?

A testicular biopsy may be used to:

• Identify whether sperm production is present.
• Retrieve sperm for use in IVF. This may be required in circumstances where sperm are being produced in the testicles but are not present in the semen,
• Diagnose testicular cancer or pre-malignant disease.
• Investigate unusual lumps in the testicles
• Diagnose causes of male infertility.
   

What does a testicular biopsy involve?

There are two types of testicular biopsy:

Core needle biopsy

This use a hollow needle (that is loaded with springs) to extract a cylinder of cells. This is called a core sample. This method is sometimes ised in the outpatient setting to obtain a representative sample of tissue, but is random in that it oes not target a specific area of testicular tissue. 
 

Open Biopsy

An open biopsy is made via a cut in the skin, usually with the delivery of the testicle. This is most often performed under a general anaesthetic, though almost always as a day-case. A small tissue sample is taken from the opening and it is closed afterwards with stitches.

When looking for sperm, this type of biopsy is often called a TESE (Testicular Exploration and Sperm Extraction), and is performed jointly by the surgeon and a fertility lab team (embryologists). The technique with the highest success rate in terms of retrieving sperm is a form of TESE using a microscope to indentify the healthiest area of tubules with the testes - called Micro-TESE. 

Dissolving sutures/stitches are then used to close the layers including skin. Whether sperm are present or not is not often kown straight away, while histological results may take a week or two to become available. 
 

Preparation for a Testicular Biopsy

If you are preparing for a testicular biopsy should let their doctor know about any over the counter medications you're taking. You should discuss whether these medications should be used before and during the test.
 

Some drugs may present a special risk during the procedure. These include:

• Anticoagulants
• Nonsteroidal anti-inflammatory drugs, including aspirin or ibuprofen
• Any medications that affect blood clotting
   

If you are receiving general anesthesia, you'll need to fast from food and drink for at least eight hours before the test. If you're given a sedative to take at home prior to the biopsy, you'll not be able to drive yourself to the procedure.

The biopsy procedure can sometimes be performed under a local anaesthetic, with or without sedation. In certain circumstances, it may be necessary to use a general anaesthetic.