Testicular biopsy and diagnosis of male infertility

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Male infertility is becoming an increasingly serious problem that is increasingly being called a disease. Male infertility has serious consequences for the whole society, but it can also be a sign of developing serious diseases such as diabetes. Check the role of testicular biopsy in the diagnosis of male infertility.

Testicular biopsy is performed on men whose doctor has diagnosed a complete absence of sperm in their semen. During the biopsy, the doctor takes a piece of tissue from the testicle or epididymis. Thanks to this, the doctor collects sperm that can be used during in vitro fertilization or insemination.

What are the causes of male infertility?

There can be many causes of male infertility. First of all, it should be remembered that this is not a sentence and not in every case it means the need to perform expensive and very invasive procedures, such as in vitro. For example, outpatient treatment, medications used or the introduction of healthy lifestyle changes are very often effective.

The causes of male infertility include:

1. abnormal position of the testicles (outside the scrotum);
2. birth defects;
3. injuries;
4. defects in the structure of the penis;
5. viral, bacterial or fungal infections;
6. autoimmune diseases, which lead to a situation in which the immune system attacks human cells, e.g. sperm, which leads to agglutination. As a consequence, sperm cease to be mobile and penetrate the cervical mucus;
7. ejaculation into the bladder, for example as a consequence of urological surgery, multiple sclerosis or sedatives;
8. medications used, e.g. anabolic steroids;
9. drugs;
10. lead;
11. smoking;
12. some dyes;
13. history of diabetes, tuberculosis, cardiovascular diseases, thyroid diseases, anemia;
14. stress;
15. tight clothes made of synthetic materials – they overheat sperm and even damage them.

There can be many causes of male infertility. However, keep in mind that usually a single factor does not usually cause the problem. The situation is dangerous when several causes occur simultaneously. Male fertility is greatly influenced by the individual characteristics of a man, as well as the fertility of the woman herself.

There are times when a woman’s hostile environment makes it difficult for sperm to reach the egg. That is why it is so important to visit a doctor together when diagnosing the causes of infertility.

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What doctor deals with male infertility?

The examination of male infertility is performed by an andrologist, i.e. a doctor dealing with diseases of the reproductive system, and a urologist, i.e. a specialist in diseases of the genitourinary system. However, it is worth remembering that you should always look for the reasons everywhere, not only in the reproductive system.

Today, consultation begins with a visit to a gynecologist specializing in the treatment of infertility. Usually, both a woman and a man come to the visit. On the basis of the interview collected during her, the doctor indicates the necessary tests and other consultations. It often turns out that different specialists cooperate with each other in the treatment of infertility. Most often it is, for example, an endocrinologist, psychologist, diabetologist, sexologist, and even a gastroenterologist.

The whole process is supervised by one doctor, often a gynecologist. It will help the couple to go through all the stages of treatment right up to the birth.

What is a testicular biopsy?

A testicular biopsy is a minor surgical procedure that involves removing tissue from the testicles. It is performed by puncturing the testicle with a needle and collecting tissue fragments. It is also possible to extract the tissue with a surgical knife. Biopsies can be performed using an operating microscope if the seminal tubules are to be collected. In addition, it is also possible to puncture the epididymis to collect a suspension from which sperm can be obtained.

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How is a testicular biopsy done?

The doctor decides about the course of the testicular biopsy based on the medical history taken. The biopsy can take the following forms:

1. needle biopsy, the so-called closed – this procedure is performed under local anesthesia, when it is possible to collect a large amount of sperm. During the procedure, the testicle is punctured through the skin with a needle. The entire procedure is short and takes about 15-30 minutes. You should come to the biopsy 15 minutes before the scheduled surgery. You should not prepare yourself for the procedure;
2. open biopsy – an open biopsy is performed under general anesthesia. It requires a precise incision of the testicular sheath, after which a section of the epididymis and other areas of the testicle are taken. Through an open biopsy, steam has a good chance of finding sperm, needed e.g. for in vitro surgery. The procedure is longer and takes about an hour. You should report for a biopsy one hour before the scheduled time of the procedure for an anesthetic consultation. After the procedure, it is also necessary to arrange a follow-up visit;
3. mapping biopsy – a procedure involving the removal of material with a needle from various places in the testicle. Mapping biopsy collects both sperm and lots of cells to test for neoplastic changes.

Sperm collected during a biopsy is divided into two groups. The first one is sent for microscopic examination. If the test result is correct, then the second part is intended for in vitro fertilization or insemination.

Be sure to read: What are the causes of male infertility?

What are the complications of a testicular biopsy?

Complications after a testicular biopsy are extremely rare. It happens, for example, pain in the testicles, hematomas, or inflammation of the testicle or epididymis.

What are the contraindications for a testicular biopsy?

A contraindication to the procedure is a visible and obvious tumor of the testicle and purulent lesions on the skin of the scrotum. A biopsy in the case of purulent lesions can spread the infection also inside the testicle. Also, do not perform a biopsy when the testicle, scrotum and epididymis become inflamed. A biopsy should also not be performed without the results of physical and hormonal tests showing disturbances in sperm production, such as high FSH levels.

When should a testicular biopsy be performed?

Testicular biopsy is a method used to harvest tissue for microscopic examination. The procedure should be performed in the case of male infertility or in the case of diagnosing neoplastic diseases, such as testicular cancer. During the biopsy, it is also possible to collect sperm for in vitro surgery or insemination.

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What role does testicular biopsy play in male infertility?

Testicular biopsy is a safe procedure that takes quite a short time and is completely painless. It is performed mainly as part of the diagnosis of male infertility, but also its treatment. During the procedure, it is possible not only to determine whether the testes are still producing sperm, but also, for example, to collect sperm for in vitro surgery or insemination.

Infertility means problems conceiving a baby, despite regular attempts over the course of 12 months. Statistics show that male infertility accounts for about 50% of the total number of cases. Male infertility is caused either by a lack of sperm in the sperm, i.e. azoospermia or oligospermia, which is a decrease in the number of sperm in the sperm. In the case of a low sperm count in semen, further diagnosis and finding the cause is necessary. This condition can be triggered by abnormal sperm production or a variety of mechanical obstructions that prevent sperm from flowing through the vas deferens into and out of the urethra.

Obstruction of the vas deferens can be caused by scars left over from inflammation. The most common inflammation is caused by an infection with E.coli, gonorrhea or chlamydia. It also happens that the testicles become inflamed during mumps.

Low sperm count can be caused by a lack of sperm-forming cells, known as the Sertoli cell complex. It also happens that sperm maturation has stopped due to contact with toxins, alcohol abuse or hormonal disorders.

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What does the collection of sperm from the testicle for fertilization look like?

During testicular biopsy it is possible, among others, to collection of sperm needed for artificial insemination. This method is used when, despite the proper production of sperm cells, they are not able to get from the vas deferens into the ovum on their own due to its obstruction. The use of the so-called assisted reproduction allows for fertilization despite various obstacles to the anatomical structure of the reproductive system.

After collection, the sperm is introduced in a special fluid directly into the uterus or fallopian tube (insemination). They can also be used during in vitro fertilization, which involves taking an egg from a woman and fertilizing it by adding a few drops of sperm in a special container. When fertilization occurs, the embryo is transferred to the woman’s uterus.

Another method of artificial insemination is to directly inject the sperm into the egg and then insert the embryo into the uterus. However, this method is much more complicated and carries a high risk of miscarriage.

How should the testicular biopsy results be interpreted?

The aim of the biopsy is to check whether the man’s testicles have well-developed and mobile sperm which can then be used during fertilization. In some cases, a biopsy can identify the direct cause of infertility and sperm deficiency.

How Much Does a Biopsy Cost?

Testicular biopsy is quite an expensive procedure. Its price ranges from PLN 1050 to PLN 3500 depending on the clinic and city.

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