Testicular biopsy

Testicular biopsy

A testicular biopsy is a small operation whereby a small piece of testicular tissue is excised to facilitate examination. Its primary use is in the infertility assessment of males or retrieval of sperm in azoospermic men (no sperm in semen).

Testicular Biopsy Surgery

The testicular biopsy surgery entails the creation of a small incision or through the utilization of a needle that removes part of the tissue of a single or both testes. It assists in determining whether production of sperms is normal or obstructed and also determine whether infertility is due to obstruction or non-obstructed factors.

Indications

• Azoospermia
• Suspected testicular failure.
• Sperm retrieval for IVF/ICSI
• Testing of undescended or abnormal testes.
• Tumour investigation (rare)

Contraindications

• Active infection
• Uncontrolled haemorrhagic disorders.

Testicular biopsy procedure

The testicular biopsy is a surgical procedure that is used to get a small piece of tissue of the testis to either be evaluated diagnostically or to retrieve sperm. It is either open surgical (TESE) or needle aspiration technique (TESA).

Preparing for Procedure 

• Medical exam: Hormone (FSH, LH, testosterone), ultrasound (if needed), semen analysis. 
• Consent: Explanation of the risks, benefits and the purpose. 
• Fasting: Indicated when a general anaesthetic procedure is desired.
• Shaving/Cleaning: Scrotal area washed and shaved.
• Drugs: Blood medicine possibly should be discontinued.

Anaesthesia

• Local anaesthesia of majority of open and needle biopsies.
• More complicated sperm retrieval (e.g., micro-TESE) under general anaesthesia.
• The scrotum and testis are deadened so that they cause minimum pain.

Positioning and Sterilisation

• Patient is in the supine position.
• Antiseptic solution is applied in the scrotal area.
• Sterile drapes are placed.

Techniques to perform the testicular biopsy

• Two types are available: open biopsy (TESE) and needle biopsy (TESA). 

Open Testicular Biopsy (TESE - Testicular Sperm Extraction) 

Steps

• The skin of the scrotum is cut with a small (1-2 cm) incision. 
• Testis is accessed or brought into the world very mildly.
• A tiny slit is made in the tunica albuginea (layer covering the testis). 
• It snips out a tiny piece of the tissue (a few milligrams). 

The tissue is either:

• Forwarded to a pathology lab to be studied under a microscope, or
• Immediately processed to retrieve sperms during IVF/ICSI.
• The bleeding is managed by the use of cautery or pressure.
• Absorbable sutures are used to close the tunica and the skin.
• Sterile dressing applied.
• Time: 20-30 minutes
• Indications: Sperm retrieval and non-obstructive azoospermia.

Needle Testicular Biopsy (TESA - Testicular Sperm Aspiration) 

Steps

• An insertionally guided biopsy needle (18-23 gauge) is introduced through the skin of the scrotum. 
• Aspirate seminiferous tubules and fluid are put under negative pressure.
• The tissue fragments are gathered in a syringe in little pieces.
• Samples are forwarded to pathology or undergone to sperm.
• Time: 10 to 15 minutes
• Best for: Obstructive azoospermia; minimally invasive option. 

Post-Procedure Care

• Light compression used to reduce bleeding.
• Patient observed 30- 60 minutes.
• Released on same day instruction.

Factors Affecting Testicular biopsy cost

The testicular biopsy cost is determined by a number of medical, hospital, surgeon and location-related variables. The factors that have a major impact on the price are:

Type of Testicular Biopsy

Various methods have varying ranges of cost:

• TESA (Testicular Sperm Aspiration) -Smaller surgery, tends to be cheaper.
• TESE (Testicular Sperm Extraction)- a bit extra because of the incision and processing of tissues.
• Micro-TESE (Microsurgical Sperm Extraction)-The most expensive one as it involves the use of an operating microscope and special surgical skills.

Purpose of the Procedure

• Diagnostic biopsy (sperm production or pathology checking) is less expensive, typically.
• Costs associated with sperm retrieval to use in IVF/ICSI are high because of: On-site embryology team
• Advanced lab processing
• Cryopreservation charges (where necessary)

Experience and Specialisation of Surgeon

• Microsurgery trains urologists and andrologists, thus more charges are imposed by them.
• High IVF/ICSI success centers might have an otherwise high professional charge.

Hospital or Clinic Category

There is a wide difference between costs according to the type of facilities:

• Elite multispecialty hospitals → increased charges.
• Mid-range of reproductive medicine centers.
• Smaller nursing homes -lowest range.
• Facilities, accreditation and equipments are other contributors.

Anaesthesia Type

• Local anaesthesia - cheaper.
• General anaesthesia = it is more expensive because of anaesthesiologist and OT fee.
• A moderate fee may also be added through sedation.

Need for Advanced Equipment

Of particular use in micro-TESE:

• Operating microscope
• High-precision micro-instruments
• Lab processing tools of specialty.
• These directly hike the cost of surgery.

Laboratory Analysis Fees

• Diagnostic Biopsy: histopathology examination.
• Embryology methods of sperm retrieval.
• Sperm freezing charges (when done) and storage charges.
• They are normally billed separately.

Unilateral or Bilateral

• Unilateral biopsy is less expensive.
• Bilateral biopsy - more expensive because of additional time, tissue manipulation and time spent in OT.

Other Medical Needs

• Pre-procedure blood tests
• Ultrasound
• Medicines
• Follow-up visits of the patients discussing results of the surgery.
• These are in addition to the overall cost.

City and Geographic Location

Costs vary based on region:

• Metro cities (Mumbai, Delhi, Bangalore) → greatest.
• Tier-2 cities → moderate
• Tier-3 towns → lower cost

Testicular biopsy recovery

The post-testicular biopsy recovery takes a short time, as the operation is least invasive. The majority of patients recover normal operations in several days. Depending on whether the biopsy is open (TESE) or needle-based (TESA), the recovery time varies slightly since an open biopsy is a little longer to heal as compared to a needle-based biopsy.

Short-term Procedure recovery

• The patient spends 30-60 minutes in the post-operative.
• The anaesthesia subsides with mild numbness in the scrotum.
• The initial few hours are reserved to apply an ice pack in order to decrease swelling.
• Home can be normally the same day.

Pain and discomfort

• Discomfort, pressure and tightness are normal and may last about 1 to 3 days after the procedure. 
• The pain relief (paracetamol/NSAIDS) can be taken before or after the procedure. 
• TESE can result in pain that is a little more prolonged than that of TESA.

Swelling and Bruising

• The scrotum can be mildly swollen or bruised and this will most likely disappear in 3-5 days.
• Discomfort is mitigated by wearing supporting underwear or a scrotal supporter.

Activity Restrictions

To promote healing:

• No strenuous activities (gym, sports, etc.) for 3-5 days.
• You should also avoid sex and masturbation for a week to prevent discomfort or bleeding.
• Avoid hot baths for 48 hours, but showering is fine. 

Wound Care

For open biopsy (TESE):

• Wipe the area of the incision with a clean cloth.
• Change dressings as advised.
• Stitches are normally absorbable and do not have to be removed.

For needle biopsy (TESA):

• No or very few stitches; just a little puncture.

Return to Work

• Desk jobs: On the next day or in 48 hours.
• The physically strenuous jobs: 3-7 days.
• Athletes: 1 week or as advised

Follow-Up

• Follow-up appointment is done normally in 7-10 days.

Testicular biopsy for infertility

Testicular biopsy is a significant diagnosis and treatment process whereby it is administered in men facing infertility particularly when their semen analysis presents azoospermia (no sperm in the ejaculate). It assists in determining whether the testicles are producing sperm and in most instances, the direct sperm retrieval can be done to assist in reproduction like in the IVF/ICSI.

Indications of Testicular Biopsy in Infertility

Testicular biopsy is advised when:

Azoospermia is detected

To determine if the cause is:

• Obstructive azoospermia (normal sperm production, obstruction at ductal level).
• It is non-obstructive, i.e. due to impaired sperm production (spermatogenic failure) and not obstructive. 

Need for Sperm Retrieval

In men with no ejaculation of sperm, there is the possibility of the sperm being trapped within the testes and they can be utilized to treat:

• ICSI (Intracytoplasmics Sperm Injection)
• IVF

To Diagnose Problems of Testicular Functions

Biopsy helps assess:

• Maturation arrest
• Sertoli-cell-only syndrome
• Hypospermatogenesis
• Tubular damage
• Testicular correlation with hormones.

The role played by Testicular Biopsy in the determination of infertility:

Ruled out the Cause of Azoospermia

The biopsy distinguishes:

• The problem of production (non-obstructive).
• Blockage issue (obstructive)
• This is essential in treatment planning.

Guides Treatment Options

Based on biopsy results:

• Retrieval of sperms and ICSI is provided.
• Hormone treatment can be recommended.
• Surgical repair (e.g., vasal obstruction repair) can be taken into account.
• Genetic counselling can be recommended.

Provides Sperm for IVF/ICSI

Small foci of sperm are frequently detected by biopsies even in extreme infertility, particularly using methods such as:

• TESA
• TESE
• Micro-TESE (optimal in non-obstructive azoospermia)

Methods of Biopsies in relationship to infertility:

Examination of Testicular Sperm Aspiration

• Needle-based
• Most effective in obstructive azoospermia.
• Quick, minimally invasive

TESE (Testicular Sperm Extraction)

• Minimal surgical intervention to remove the tissue.
• Increased probability of identification of sperm.
• Applied in infertility procedures.

Micro-TESE

• Operating microscope microsurgical technique.
• Gold criterion of non-obstructive azoospermia.
• Maximum sperm retrieval rate.
• Lower tissue damage

Advantages of Testicular biopsy in infertility

• Makes correct diagnoses of cause of infertility.
• Gives a first-hand evaluation of the production of sperm.
• Permits sperm harvesting to ART (Assisted Reproductive Technology).
• Helps do not have unnecessary surgeries.
• Enhances treatment planning and success.

Best hospital for testicular biopsy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Testicular biopsy provides important diagnostic and therapeutic information, especially in the diagnosis and treatment of male infertility. This helps to know if there is normal sperm production and cause of azoospermia as well as obtain sperm for use in performing other more complex reproductive procedures, such as ICSI. It is a minimally invasive procedure that is safe and normally done as a day-care procedure with a short recovery period. The modern methods of TESE, TESA, and micro-TESE allow numerous infertile men to have a biological child. Knowing the purpose and process, recovery and cost factors are useful in making informed decisions and selecting the most appropriate treatment pathway by the couples.

Testicular biopsy surgery India GetWellGo

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
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• Assistance in selecting India's top hospitals for testicular biopsy surgery.
• Top urologists who have a proven record of success
• Support during and after treatment. 
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food

FAQ

1. Is the procedure painful?

• No. Local/general anaesthesia will avoid the pain during the process. It can be followed by some mild discomfort during 1-3 days.

2. Does a biopsy have any implications on fertility?

• No. A biopsy has no effect on future sperms or fertility.

3. Is sperm always present in biopsy?

• Sperm retrieval is virtually guaranteed in case of obstructive azoospermia.
• Success in non-obstructive azoospermia (30-70) occurs with micro- TESE having the highest success.

4. Do stitches need removal?

• A majority of the biopsies require absorbable stitches which vanish by themselves.