What is a Testicular Biopsy?
A testicular biopsy takes a tissue sample from your testicle for
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
- diagnose causes of male infertility
- obtain sperm for in vitro fertilization (IVF)
There are two different procedures for a testicular 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
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
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.
- 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
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.
If you are having an open biopsy, the following procedure is
physician will make a small incision through the skin.
tiny, pea-sized amount of testicular tissue is removed.
the biopsy is taken, you will feel pressure or minor discomfort. You should not
one absorbable stitch closes the cut in the testicle. Another stitch closes
your skin. Stitch removal is not necessary.
same technique is done on the second testicle.
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
- 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
Diagnosing Testicular Cancer
Testicular biopsy is rarely used to diagnose testicular cancer.
Typically, it is performed when the diagnosis is uncertain. This is because a
biopsy, unfortunately, increases the likelihood the cancer will spread.
Your physician is more likely to use ultrasound for cancer
diagnosis. Your testicle can also be examined and removed through open surgery.
This is called a radical inguinal orchiectomy.
A radical inguinal orchiectomy to diagnose cancer includes the
physician will make a cut in your groin.
testicles will be removed from the scrotum and examined.
abnormal tissue is found, a small portion will be taken for analysis.
pathologist will examine the tissue. This will be done immediately, while you
the tissue sample is benign (noncancerous), the testicle will be returned to
the tissue sample is malignant (cancerous), the testicle will be removed. The
spermatic cord will be removed as well. This prevents the spread of cancer
cells to the rest of the body.
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
- 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
- bleeding that soaks the bandage at the biopsy
- 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
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
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
- testicular cancer