Male Fertility Testing. Recommendations before treatment and biopsies.

When Do You Need a Testicular Biopsy?

As long as there are sperm present in the ejaculate DO NOT ALLOW anyone perform a biopsy with the hope of finding more sperm in the testes. Biopsies of the testes may damage delicate genital structures, drain your finances and may not achieve the objective of having a baby. Therefore, your doctor should exhaust all other measures before using these more invasive diagnostic procedures. With less invasive tests, such as an ultrasound of the prostate, it can be predict pretty well whether or not you have an obstruction.

If you are having an exploratory biopsy due to complete lack of sperm in the ejaculate ALWAYS ask the physician to freeze any sperm obtained in the procedure. Ask to distribute the sperm in 5-6 vials for multiple attempts of ICSI. The sperm can be used later to initiate a pregnancy. There is no reason to have more than one biopsy unless there are other mitigating circumstances. If he/she does not feel the need to freeze sperm then he/she does not know better or does not have your best interest in mind. Go to another physician who cares about you.

When a Testicular Biopsy Can and Can Not Be Helpful

It is helpful if you have azoospermia with low or normal FSH levels.
It is helpful if you have azoospermia with normal hormone levels and normal testicular size.
If you have severe oligozoospermia or there are a few sperm in the ejaculate DO NOT ACCEPT A TESTICULAR BIOPSY!!! Chances of success will not increase but you will pay dearly for something that will not shed too much information.

How to Interpret Testicular Biopsy Findings

If you are Azoospermia and have a normal testes biopsy, you definitely have a tubal blockage.
If you are oligozoospermia because your testes are performing at an abnormally slow rate, you may have hypo spermatogenesis.
If you are Azoospermia because your testes cannot complete the sperm maturation process, you may have maturation arrest.

Hypospermatogenesis and Maturation Arrest

If the biopsy finds reduce spermatogenesis (perhaps a phase of maturation arrest), you will show diminished germ (germination) cell activity and marked germ cell loss. Since the germ cells are the precursors of sperm, you will produce low numbers of sperm or no sperm at all. Chemical toxins, drugs, and genetic problems may reduce spermatogenesis. With maturation arrest, one of the most frequent biopsy findings in male fertility, your germ cells divide and produce early sperm forms, and other testicular structures will appear normal. At one stage in their maturation, however, sperm development halts throughout all testicular tubules. The condition may be complete (azoospermia) or partial (oligozoospermia). Chemical toxins, drugs, and genetic problems may cause maturation arrest. If the FSH level is high, indicating severe testicular damage, it may be too late for treatment. However, if the FSH level is low or normal, removing the cause(s) rarely restore spermatogenesis. The best chance of success is to use anonymous semen donor.