Testicular Biopsy and Epididymis Aspiration

Testicular biopsy is a superficial surgical procedure that involves the removal of one or more pieces of tissue through small incisions made in the testicle. It is a painless procedure, during which the patient is given local or general anaesthetic. The biopsied tissue is immediately analysed by embryologists in the laboratory, where a microscope is used to study the presence of sperm, as well as other cell types.

A less invasive alternative

is epididymis aspiration, which involves the extraction of sperm directly from the epididymis, the duct that leaves the testicle and where sperm are stored and matured. It can be assessed as a step prior to testicular biopsy. The biopsy is carried out for two purposes:

Diagnosis: study the cause of male infertility. We can determine if azoospermia (absence of sperm in the ejaculate) is obstructive or secretory.

Obstructive azoospermia: when the seminal ducts are blocked but sperm production in the testicle is normal.

Secretory azoospermia: When sperm production or spermatogenesis is affected in the testicle.

Therapeutic: obtaining sperm in cases of azoospermia, which can be used in a fresh in vitro fertilisation cycle or frozen for future use.

There are two types of testicular biopsy:

Testicular Sperm Extraction (TESE):

This consists of an open biopsy of the testicle, which involves making an incision in the scrotum and another in the testicle itself. The goal is to obtain tissue fragments containing seminiferous tubules.

Testicular Sperm Aspiration (TESA):

this is a percutaneous biopsy or aspiration, less invasive than TESE. It involves perforating the testicle with a needle connected to a syringe. It can be performed as a step prior to open biopsy.

Suitable for:

Congenital absence of vas deferens

Cystic fibrosis

Infections/inflammatory processes

Vasectomy

In addition, the biopsied tissue can be subjected to studies that provide more information:

Histological study:
Testicular tissue and its ability to produce sperm are analysed. With this study, we can find out at which point of the maturation phase spermatogenesis has stopped.

Meiosis or cytogenetic study:
To evaluate the chromosomal arrangement and composition of the different phases of spermatogenesis. It is especially recommended in cases of repeat miscarriage or altered sperm motility parameters.

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