Why is testicular biopsy the last way to save male fertility?

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Why is testicular biopsy the last way to save male fertility?

Among infertile couples, male factors account for about 50% of infertility. Among male infertility patients seeking treatment, azoospermia accounts for 5%-10%. Therefore, infertile couples are very infertile. Concerned about the problem of azoospermia.

Semen examination revealed no sperm, which we call azoospermia.

As one of the most difficult to treat infertility, azoospermia has caused a lot of pain to patients and numerous troubles to doctors.

Among the many diagnosis and treatment techniques for male infertility, there is a very important examination and treatment method-testicular biopsy. This examination is clinically hailed as “the last line of defense for male fertility”, so let’s talk about it today. Talk about this testicular biopsy.

What is a testicular biopsy?

Testicular biopsy, the full name is also called testicular tissue biopsy. It is essentially the same as kidney biopsy and liver biopsy. It is a clinical technique with dual functions of diagnosis and treatment.

A small piece of living body is removed through a simple surgical method. The testicular tissue is observed by pathological slices under a microscope to search for sperm.

On the one hand, you can understand the status of testicular spermatogenesis, and on the other hand, you can observe what the testicular tissue looks like, whether there are lesions, what lesions are they, and the extent of the lesions. How is then used to diagnose testicular disease, determine treatment strategies and assess prognosis.

At the same time, in the obtained testicular tissue, if there is sperm, it can be taken out as a “seed” for the treatment of male infertility.

Why is a testicular biopsy called the “last line of defense”?

First, we briefly introduce the process of sperm production.

Sperm is produced in the seminiferous tubules of the testis, that is, the curved tubules in the testes in the picture, then enter the straight seminiferous tubules, then enter the efferent tubules and then to the epididymal duct, from the epididymal duct to the vas deferens and finally stored in the seminal vesicles .

The development and maturity of a sperm has gone through a complicated process, and it takes about 3 months to develop and mature continuously in the process of production and transportation.

Going back to the previous question, in clinical practice, we actually have many methods to judge the sperm production ability of men, such as semen examination, testicular ultrasound, and indirect judgment through some hormones and biochemical indicators. However, compared with testicular biopsy, these inspection methods cannot accurately reflect the spermatogenic function of the testis.

Because testicular biopsy is to directly examine the seminiferous tubules of the testis, that is, to check the source of sperm production, while endocrine and biochemical examinations are indirect understanding of spermatogenic function.

Therefore, testicular biopsy is the gold standard for diagnosis of testicular spermatogenesis and the last line of defense for male fertility.

If the testicular puncture test finds that there is no ability to produce sperm, then there is a high probability that it is gone. However, the testicular biopsy may also fail to obtain a spermatogenic site due to the location of the material.

What is the significance of testicular biopsy?

As mentioned before, testicular biopsy currently has two main functions:

①Used for disease diagnosis:

testicular tissue biopsy is mainly used for azoospermia patients, azoospermia patients through perfect sex hormones, inhibin B, Y chromosome microdeletion, chromosome karyotype analysis, seminal plasma biochemistry, scrotal color Doppler ultrasound, etc.

The examination can preliminarily determine whether it is azoospermia caused by spermatogenic dysfunction or azoospermia caused by obstruction of the sperm transport pipeline. Then select the appropriate testicular biopsy technique to obtain testicular tissue, which can be used to understand and judge the spermatogenesis of the testis according to the testicular tissue structure and the degree of development of germ cells.

It is of great value for the diagnosis, classification, treatment and prognosis of azoospermia. This is something that methods such as semen examination, sex hormone examination and testicular ultrasound examination cannot do.

②For disease treatment:

the second half of the full name of testicular biopsy, namely sperm retrieval, can freeze the retrieved sperm for later use, thawing it when needed, or directly pass the retrieved sperm through the sperm in the oocyte The method of injection, that is, the second-generation IVF, allows azoospermic patients to obtain their own offspring and treat the disease.

Who is suitable for testicular biopsy? Who is not suitable for it?

At present, clinically, the main indications for testicular biopsy include:

1) Patients with azoospermia;

2) Patients with severe oligospermia;

3) Obstructive azoospermia, before the microsurgical anastomosis operation, do bilateral testicular biopsy to determine which side is suitable for surgery;

4) A biopsy of cryptorchidism patients can be used to detect malignant changes;

5) A biopsy of a testicular mass of unknown cause confirms the diagnosis;

6) To evaluate the long-term effects of male birth control or environmental factors, cytotoxic drugs, and radiation on the spermatogenesis of the testis, a testicular biopsy can also be done.

Testicular biopsy has the dual value of diagnosis and treatment. Patients with azoospermia can obtain sperm through testicular biopsy and then undergo assisted reproductive assistance. Non-obstructive azoospermia can not obtain sperm and assisted reproductive assistance is now possible through testicles. Microscopic sperm extraction is used to obtain sperm, and the overall sperm capture rate can reach about 43%-63%.

What are the methods for testicular biopsy?

There are currently three main methods for testicular biopsy:

①Open testicular biopsy and sperm extraction:

It is a traditional testicular biopsy. The method is to make a small incision on the surface of the testis and obtain a small amount of testicular tissue for examination. This method is more traumatic, has many complications, and postoperatively. Shortcomings such as slow recovery, are not used much now;

② Testicular fine-needle aspiration:

This is the most commonly used method in clinical practice, that is, a puncture needle is used to penetrate the testis through the skin, and then a small amount of testicular tissue is drawn out for inspection through negative pressure suction.

The advantages of the puncture method are that the damage is small, the operation time is short, the patient’s pain is very small, the postoperative complications are minimal, and the recovery is fast, and it basically does not affect the patient’s life; but we all know that a biopsy taken at a single site The tissue does not truly reflect the condition of the entire testis.

In the testicles, the production of sperm is not uniform. In some areas, spermatogenesis will be very vigorous, while in some areas, spermatogenesis will be very poor, and there will be no signs of spermatogenesis. Therefore, when using this method, it is often necessary to take materials from at least 4 different parts, and then submit them for inspection separately.

③Testicular microscopic sperm extraction:

This method is to use an operating microscope to magnify the field of view to find the seminiferous tubules that may have spermatogenic function after the testicular capsule is incised.

The appearance of the seminiferous tubules is different Obvious difference, so that sperm can be retrieved without damaging more testicular tissue, and the rate of sperm retrieval can be increased.

Compared with the previous method, this method can avoid the situation of not getting the sperm, and is more accurate in diagnosis, so it has more advantages in the treatment of infertility.

However, this method is a hospitalized operation, which is more traumatic.

Will testicular biopsy cause much painful?

Many patients have experienced the feeling of pain in their lives, and they are also very worried about whether the pain will be too strong during testicular biopsy.

For conventional testicular puncture operations, spermatic nerve block and local testicular anesthesia are used for anesthesia. Therefore, the patient only feels a little pain when injecting the anesthetic, and there is no pain during the operation, and walking as usual after the operation.

For patients with testicular microsurgery, it is necessary to perform the operation when the patient loses consciousness after intravenous anesthesia.

After the surgical anesthesia is over, the patient may feel a little pain, and everyone has a different tolerance to the pain, but in general, the testicular biopsy does not appear pains.

Will there be any damage to the testes after testicular biopsy, and what are the side effects?

Normal male testicles contain 300-1000 seminiferous tubes, generally about 600 on average, each about 30-70 cm long. All these seminiferous tubes are placed in a straight line, and the total length exceeds 260 meters.

The testicular tissue removed from the testicular puncture is extremely small, so it will not cause great damage to the testis, nor will it cause sequelae such as impotence and sperm production.

In terms of other side effects, it is mainly divided into the side effects of anesthetics, allergies to anesthetics, and some losses caused by testicular biopsy, such as anti-sperm antibodies, local pain, intraoperative bleeding, infection and other risks.

But overall, these side effects are relatively low, and testicular biopsy is still a safer operation.

What preparations should be made before and after the testicular biopsy?

Before testicular biopsy:

①Before testicular biopsy, patients should undergo routine blood tests and coagulation tests to avoid adverse reactions during the operation.

② Proper diet, maintain adequate physical strength and energy, and do a good job of sanitation and cleaning.

③ Avoid taking aspirin and other drugs that affect blood coagulation 7-10 days before puncture.

After testicular biopsy:

①It is necessary to press the testicles carefully for 30 minutes. Prohibit sedentary sitting for 3 days, and sex life for 1 week.

②Be careful to rest after the operation. Anti-inflammatory drugs can be taken orally until five days after the operation. Keep the operation site dry. Do not exercise vigorously within two weeks.

③There will be undesirable symptoms after the operation, such as pain in the surgical site and lower abdomen, and a small amount of blood oozing from the surgical site, all of which are normal. The sterile gauze can be taken off after 2-3 days.

④ If there is severe pain at the surgical site, scrotum enlargement and fever are found, you should go to the emergency department of urology in time.

⑤ It is recommended to avoid eating spicy and irritating food, avoid smoking and drinking, so as not to be harmful to the recovery of the incision.