What is a Testicular Biopsy?

A testicular biopsy takes a tissue sample from your testicle for laboratory analysis.

The two testicles are the male reproductive organs. They produce sperm and the male sex hormone testosterone. Your testicles are located in your scrotum, which is the fleshy pouch of tissue that hangs under your penis.

A testicular biopsy can be used to:

diagnose the location and condition of a lump in the testes
diagnose causes of male infertility
obtain sperm for in vitro fertilization (IVF)

There are two different procedures for a testicular biopsy.

Percutaneous Biopsy
With percutaneous biopsy, a thin biopsy needle is inserted through the skin. The needle has a syringe on the end to collect the testicular tissue. This procedure does not require an incision or stitches. It also is called a fine needle biopsy.

A core needle biopsy is a variation on this technique. It uses a hollow, spring-loaded needle to extract a cylinder of cells. This is called a core sample. A core sample is a larger specimen than one from a fine needle biopsy.

Open Biopsy
An open biopsy is also called a surgical biopsy. Your doctor starts by making a cut in the skin. A cut also is made in the testicle. Then a small tissue sample is taken from the opening and stitches are used to close the cuts.

Diagnostic Uses of a Testicular Biopsy

A testicular biopsy is an important tool in diagnosing male infertility. However, it is not the first step. For the initial phase in a fertility evaluation, your doctor will take a health history and order blood tests and a semen analysis.

Semen analysis looks at the quantity and quality of your sperm. The initial semen sample is usually obtained by masturbation.

Semen analysis can identify the following problems:

abnormally low levels of sperm
poor quality of sperm
azoospermia (absence of sperm)
Blood and hormone tests often can identify the causes of low sperm levels. However, when these tests are not conclusive, you may need a testicular biopsy.

A testicular biopsy may be used to:

determine whether sperm production problems are caused by a blockage
retrieve sperm for use in IVF. This is done if sperm are being made in the testicles but are not present in the semen.
diagnose testicular cancer
determine the cause of a lump in the testicles

Preparation for a Testicular Biopsy

The preparations required for this test are minimal.

Tell your physician about any prescription or over-the-counter medications you are taking. Discuss whether these medications should be used before and during the test.

Certain drugs may pose a special risk during the procedure. These include:

anticoagulants (blood thinners)
nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin or ibuprofen
any medications that affect blood clotting
If you are receiving general anesthesia, you will need to fast from food and drink for at least eight hours before your test. If you are given a sedative to take at home before the biopsy, you will not be able to drive yourself to the procedure.

Administration of a Testicular Biopsy

A testicular biopsy is usually an outpatient procedure. It may be performed at your doctor’s office or a hospital.

The biopsy typically takes about 15 to 20 minutes. It is performed by a doctor or another trained health professional.

You may be offered a sedative to help you relax for the test. Since you have to stay completely still, some doctors prefer to use general anesthesia instead. With either medication, the biopsy technique remains the same.

You will be asked to lie on your back and the scrotum will be cleaned to remove bacteria. An injection of local anesthesia will numb the skin of the scrotum. You may feel a slight sting.

Open Biopsy
If you are having an open biopsy, the following procedure is typical:

Your physician will make a small incision through the skin.
A tiny, pea-sized amount of testicular tissue is removed.
When the biopsy is taken, you will feel pressure or minor discomfort. You should not feel pain.
Typically, one absorbable stitch closes the cut in the testicle. Another stitch closes your skin. Stitch removal is not necessary.
The same technique is done on the second testicle.
Percutaneous Biopsy
The procedure for a percutaneous biopsy will depend on the type of needle used — a core needle or a fine needle.

In both cases, a needle is inserted through the skin of the testicle.
If you are having a core needle biopsy, you will hear a loud clicking or popping sound when the tissue sample is being extracted.
If you are having a fine needle biopsy, the tissue sample will be drawn out with a syringe.
The same technique is done on the second testicle.

Recovery from a Testicular Biopsy

After your testicular biopsy, you will receive special instructions to help you heal and remain comfortable. Instructions will vary depending on the type of biopsy.

You may be advised to:

refrain from sexual activity for one to two weeks
wear an athletic supporter for several days
keep the site of the biopsy dry, and avoid washing it for several days
avoid aspirin for one week
use acetaminophen for soreness
It is normal to have swelling, discoloration, and discomfort for a few days. A small amount of bleeding is also common. Your doctor may also warn you about other routine side effects that are procedure dependent.

Risks of a Testicular Biopsy

A testicular biopsy can help your doctor resolve your infertility problems. It does not carry a risk of erection or fertility problems after the procedure.

Prolonged bleeding and post-procedure infection are two potentially serious risks. However, they are rare. Contact your physician if you experience:

bleeding that soaks the bandage at the biopsy site
hematoma (a collection of blood under the skin)
severe pain or swelling of the scrotum
fever or chills
Another possible risk is internal damage to the testicles or nearby areas. This is rare.

Interpreting the Results of a Testicular Biopsy

Your tissue sample will be analyzed under a microscope. The pathologist will identify any defects in sperm production or development.

Your results may show normal sperm development. If you previously had a low or zero sperm count, an obstruction may be the cause of your infertility.

Blockages in the vas deferens have been shown to cause this type of infertility. The vas deferens is the tube that carries sperm from the testicles to the urethra. Surgery may be able to correct the problem.

Additional causes of abnormal results include:

spermatocele: a fluid-filled cyst on the ducts of the testicles
orchitis: a swelling of the testicles caused by an infection
testicular cancer