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An ultrasound of the testis has become a popular test to order, but its helpfulness is limited. The size of the testis is better assessed by clinical examination, using an orchidometer; and while a Doppler ultrasound will often diagnose the presence of a varicocele, this is usually of little clinical significance. The danger of finding a varicocele is that the knee-jerk response is to do surgery to correct it and this rarely benefits the patient. A transrectal ultrasound (TRUS) can be useful, but only in evaluating selected patients with obstructive azoospermia, when a block at the level of the seminal vesicles is suspected, and this test is best ordered by a specialist.
A testicular biopsy is done in order to find out whether sperm production in the testis is normal or not. This is the "gold standard" for judging testicular function, since here the testicular tissue is being examined directly.How is a testicular biopsy performed? This is a simple surgical procedure, which can be done under a local anaesthetic, in an operation theatre or even in the doctor's clinic, if it is well equipped. The test takes about 5-10 minutes to be carried out; and a biopsy could be taken from just one testis, or from both testes, depending upon the nature of the problem.
The removed bit of tissue is then placed in a special preservative fluid, which is then sent to a pathologist for examination under a microscope after staining.
The biopsy surgery doesn't hurt, because the local anesthetic numbs the tissues. There may be dull ache for a few days after the procedure, but this can be relieved by mild analgesics.
Since testis biopsy is a surgical procedure, most doctors would use it as the last resort when testing the man. If you are advised to have a testis biopsy, ask the doctor how the result will change your treatment (a question you should ask before being subjected to any medical test, in fact!).
The only group of infertile men who should be offered a testis biopsy are those with azoospermia. Men with oligospermia should not be subjected to a testis biopsy because the biopsy report is always normal in these men (and this is not surprising - after all, since sperm are present in the semen, they are obviously being produced in the testes!)
Formerly, when doctors performed a testis biopsy, they would send only one chunk of tissue for testing. However, today we know that a single biopsy may not be representative of the entire testis. Sperm production is not uniformly distributed throughout the testis, especially in men with testicular failure. This means that in order to get a true picture of sperm production in the testis, the doctor needs to sample at least 4 different areas of the testis, all of which need to be examined.
In the past, a testis biopsy was purely a diagnostic procedure. Today, it is also used to retrieve testicular sperm in order to treat men with severe male factor infertility. These testicular sperm can be used for intracytoplasmic sperm injection (ICSI), a procedure described in detail in Chapter. Specialised infertility clinics also have the ability to freeze the testicular tissue. This testicular sperm freezing can be very useful, especially in men with small testes, as the biopsy does not need to be repeated again during treatment.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
