Testicular biopsy in cases of azoospermia

It is rather impossible to conceive naturally having azoospermia. If it cannot be reversed surgically, it might be worth considering the use of assisted reproduction therapies. However, the chances of becoming biological parents depend on the type of azoospermia.

Men with obstructive azoospermia (non-secretory) have 100% chances of being biological fathers. On the contrary, men with the secretory type will not have more than 50% chances, provided that there are not other concurrent fertility problems.

In most of the patients with secretory azoospermia (testes not producing any sperm), some traces of spermatogenesis can be observed leaving the door open to the retrieval of viable sperm. Therefore, testicular biopsies are used to look for them.

Procedure

It is an outpatient surgery of approximately 15 minutes, performed under local anesthesia. Internal testicular tissue is removed with a small incision. The sample will be evaluated to determine the presence of spermatozoa.

The sperm obtained through biopsy is often frozen to be used in fertility treatments, like in vitro fertilization by means of ICSI (intracytoplasmic sperm injection).

Follow-up studies

Once the testicular tissue is removed, two types of follow-up studies can be conducted:

  • Histological study: the sperm production capacity of the tissue is analyzed, as well as when spermatogenesis is interrupted.
  • Meiosis study: it evaluates the chromosomic structure, composition and disposition in each stages of sperm production, ruling out male-related recurrent miscarriages.

Indications

A biopsy is usually performed to find the cause of infertility when a semen analysis shows abnormal spermatozoa and other tests have not been conclusive.

Thus, it is indicated in cases of azoospermia, oligospermia and severe alterations of semen quality associated in which there might be a high risk of having sperm with chromosomal alterations. Moreover, this technique can be performed to determine the size of a tumor.

Risks

There is a small risk of infection or bleeding. Also, the man may feel some discomfort around the genital area during 2-3 days after this intervention.

Abstaining from sex for one or two weeks as well as keeping the area dry during several days after the procedure is advisable as well.

Generally, it is also recommended not to take acetyl salicylic acid (Aspirin) in the previous or following week of the testicular biopsy.

3 comments

  1. avatar
    divya kalyani

    Hello madam,

    My husband in previous reports was having a sperm count of 78000 and staphylococcus, but in current report there’s no staphylococcus. However, it shows azoospermia. What method could we use to conceive a baby now?

    • avatar
      Sandra F.inviTRA's Moderator

      Hello divya,

      in case of azoospermia, the recommended fertility treatment is testicular biopsy + ICSI (the latter only in case sperm are found in the ejaculate). If the sperm count is zero, then IVF or artificial insemination (AI) with sperm donation.

      I hope I have been able to help,

      Regards

  2. avatar
    Jandice

    I had surgery for this in Belgium, the “doctor” butchered one of my testicles and did not inform me that he did not have the microscope in the operating theater, other hospitals have the microscope in the theater which makes a big difference.

    He is supposed to be one of the best fertility doctors in the country, from my experience he is not.

    I suffered for three years of ongoing chronic pain, panic attacks and depression after this operation.

    The butchered testicle is not in atrophy, thanks doc!

    I even tried to take him to court, but the lawyers told me I have no case.

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