Diagnostic testicular biopsy with sperm extraction:
A testicular biopsy can be performed in the office under local anesthetic or with sedation in order to extract sperm for in-vitro fertilization. This may be indicated in men with a blockage of the reproductive tract who are not good candidates for reconstructive surgery or whose female partners require reproductive assistance. The sperm can also be cryopreserved at this time to be used for in-vitro fertilization at a different date.
Microsurgical testicular dissection and sperm extraction
Patients who have had a previous biopsy showing no sperm or failed biopsy with testicular extraction are candidates. Patients with high risk factors for isolated islands of sperm producing tissue likely to be missed with conventional biopsy are candidates. These include those patients with certain genetic conditions such as Kleinfelter’s syndrome or AZF-c Y-chromosome micro deletions and those with a history of chemotherapy or undescended testicles.
A general anesthetic is used along with local anesthetic. A scrotal incision is made and a incision is made in the testicle allowing exposure of the sperm producing tissue. An operating microscope is used to examine the testicle for viable sperm tubules. The sperm tissue is examined by an embryologist in the OR or lab and if necessary both testicles can be surveyed for sperm. Sperm are cryopreserved for future in-vitro fertilization.
There may be some mild swelling and discomfort afterwards similar to a vasectomy. Ice will help with scrotal swelling. Tylenol and ibuprofen are recommended for pain. Patients should wear a scrotal support or compression shorts for the first week to minimize swelling and discomfort. It is ok to shower but no tub soaking or swimming for 2 weeks. Patients may resume regular physical and sexual activity at 2 weeks.