A testicular biopsy is a minor surgical procedure that becomes necessary when no sperm exists in the ejaculate of the male partner (azoospermia) due to an obstruction in the seminal ducts. It can be done either by needle aspiration or by surgical means however the latter is more commonly practiced since it results in greater quantity of sperm collected, some of which can be stored for future procedures.
It is performed to help determine the cause of male infertility, obtain sperm for an IVF-ICSI treatment, or diagnose the location and condition of a lump in the testes.
There are three different extraction procedures for a testicular biopsy.
MESA (microsurgical epididymal sperm aspiration)
During a MESA procedure, sperm is removed from the epididymis through a small incision in the testicle. The epididymis is a long, coiled tube that rests on the backside of each testicle. Its primary function is to carry and store sperm cells that are produced in the testes. This procedure is done under local anesthesia.
MESA is most often performed in men with no sperm in their ejaculate due to a blockage in the epididymis or vas deferens which could have resulted from a vasectomy, previous hernia repair, or a congenital absence of a portion of the male reproductive tube.
TESA (testicular sperm aspiration)
TESA is a procedure that involves sticking a needle in the testis and aspirating fluid and tissue with negative pressure. It is a less invasive technique, however, it results in less sperm collected.
TESE (testicular sperm extraction)
Sperm in its immature form is taken from the testis, in this procedure, and is done under local anesthesia. Because it has not been able to “mature” which requires it to pass through the epididymis, testicular sperm need ICSI in order to fertilize an egg.
Testicular sperm extraction is necessary for patients who have a blockage in the epididymis very near the testis that may have resulted from birth, a previous surgery, an infection, or have a blockage within the ducts of the testes.
After collection, the sperm are analyzed, frozen, and stored for use when the eggs are retrieved and prepared to be fertilized.