Diagnostics and sperm retrieval
Under the blockade of the spermatic cord or sedation, through a mini-incision of the scrotum and tunica albuginea, tissue fragments the size of a grain of rice are taken (if possible from two or three points and both testicles), some are fixed in a special solution for histology, some are immediately examined by an embryologist: the found sperm are frozen for future IVF-ICSI to avoid repeated surgery. The shell is sutured with microsutures. After 7–14 days, the pathologist describes spermatogenesis using the Johnsen scale, and the andrologist plans treatment: tract reconstruction, MESA, Micro-TESE, or hormonal therapy.
Why is a testicular biopsy necessary?
For azoospermia, a biopsy answers the main question: does the testicle produce sperm. The histological picture distinguishes between obstructive azoospermia (spermatogenesis preserved - reconstruction or MESA indicated), hypospermatogenesis, maturation block and Sertoli cell only syndrome (Micro-TESE, hormonal preparation or donor sperm). At the same time, the found sperm are frozen for IVF-ICSI. A biopsy is also performed if carcinoma in situ is suspected in men with a tumor of the second testicle.
Security
The biopsy does not affect hormonal function: less than 1% of the tissue is removed. Complications are rare - hematoma, inflammation; their prevention is supportive clothing and cold. For non-obstructive azoospermia, Micro-TESE is preferred over conventional biopsy, which simultaneously looks for sperm under a microscope.
