“Open” Biopsy of the Testis and Testicular Sperm Extraction

Abstract

Modern reproductive medicine offers new possibilities for treating infertility in men, including, among other approaches, the freezing of gametes or parts of the male or female sex gonad. In fertility practice, clinical indications for cryopreservation include storage of spermatozoa, testicular and ovarian tissues, and early embryos. Apart from freezing spermatozoa, the introduction of intracytoplasmic sperm injection into the oocyte (ICSI) in the late 1980s also created a need to freeze the testicular parenchyma. In the ICSI procedure, an oocyte is fertilized by injecting a single spermatozoon. Men with a low spermatozoa count, low spermatozoa motility, or a lack of healthy spermatozoa must provide a sample with a few viable male gametes for ICSI. Several techniques for spermatozoa retrieval from the epididymis and testis have been described and may successfully be combined with ICSI, including microsurgical epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular spermatozoa aspiration (TESA), and testicular spermatozoa extraction (TESE). TESE has been used to treat cases of obstructive and nonobstructive azoospermia. Thus, frozen–thawed pieces of testicular tissue are usually used for TESE in the case of severe male infertility, including in men with azoospermia and testicular tumors. If the tumor is not too large and the surrounding testicular parenchyma is relatively preserved, one may obtain multiple testicular biopsy samples from that area and use them for TESE/ICSI.