Testicular Biopsy, Aspiration and Sperm Extraction

Testicular Biopsy and Aspiration refers to specialised techniques to extract sperm from male patients with severe infertility.

There are a number of techniques currently available, which may be offered to you as part of your fertility treatment.

Sperm Retrieval Techniques –

Testicular Sperm Aspiration (TESA)

Testicular Sperm Aspiration (TESA) is a procedure that can be utilised for two main purposes:

  1. It can be used as a diagnostic procedure to diagnose obstructive Azoospermia. This is a medical condition where sperm is absent from seminal fluid.
  2. It can be used to collect sperm directly from the testicles of men with obstructions or ejaculatory problems that cannot be treated by any other methods.

During the procedure, a very fine needle is passed directly into the testicles under anaesthetic. A very small amount of the Seminiferous Tubules is collected. These tubules form a complex network within the testicle, where the sperm are produced. The collected material is processed in the laboratory and checked for the presence of sperm.

Sperm collected this way can be used immediately for ART treatments, or frozen for later use. However, the sperm collected in the TESA procedure are not as mature or motile as the sperm found in ejaculate, which means that they cannot fertilise a mature egg without the aid of the Intracytoplasmic Sperm Injection (ICSI) In Vitro Fertilisation (IVF) procedure.

Percutaneous Epididymal Sperm Aspiration (PESA)

Percutaneous Epididymal Sperm Aspiration (PESA) is a procedure used to collect sperm directly from the epididymis (i.e., the tiny collecting tubes next to the testicles), under local or general anaesthesia. A fine needle attached to a syringe is gently inserted into the epididymis and the fluid aspirated. The epididymis is the structure into which the sperm first flow after developing and leaving the testicles.

PESA is an excellent choice for men who have had a vasectomy, as well as for those with congenital or acquired obstructions of the genital tract (e.g., absence of the vas deferens).

As with TESA, sperm retrieved with PESA can only be used in conjunction with ICSI treatment.

Importantly, this procedure is not always successful, and there is a chance that no sperm will be collected. In these cases, the specialist may have to perform an Open Testicular Biopsy or TESA.

Open Testicular Biopsy

Open Testicular Biopsy is an invasive, operative procedure used to obtain sperm by surgically opening the scrotum and removing a small amount of Seminiferous Tubules from the testicle. The procedure must be performed in the operating room under general anaesthesia.

Open Testicular Biopsy is used in men who have undergone vasectomy, as well as in those with congenital or acquired obstructions of the genital tract (e.g., absence of the vas deferens).

This technique is often performed when TESA has been unsuccessful. As with PESA and TESA, sperm obtained with Open Testicular Biopsy can only be used in conjunction with ICSI treatment.

Vibrostimulation or Electroejaculation

For men with spinal cord injuries, neurological disorders and ejaculation problems, there are two simple sperm retrieval options available.

Vibrostimulation is a procedure performed using a special vibration device applied directly to the penis to produce an ejaculation.

Electroejaculation is a procedure whereby a special probe is inserted into the rectum to stimulate the pelvic nerves and cause ejaculation.

The sperm collected via these techniques can sometimes be used for Artificial insemination (AI) but due to low sperm numbers, the samples are more commonly used for IVF or ICSI.

Testicular Biopsy, Aspiration and Sperm Extraction – what are the potential risks?

Men contemplating these procedures for sperm collection should be aware that they carry risks comparable with elective surgery.

It is important that you discuss the risk and benefits with your treating specialist prior to undergoing any procedure. You should also be prepared to talk about your concerns in order to feel comfortable with proceeding.