Testicular Biopsy in Singapore
Testicular biopsy for male infertility diagnosis and sperm retrieval in Singapore. Learn about TESE, FNA procedures, recovery, and fertility evaluation options.
Dr. Lie Kwok Ying
BA MBBChir (Cantab)|MRCS (Edin)|FRCS (Urol)(Glasg)|FAMS
For couples experiencing fertility challenges, understanding the underlying causes is essential for finding the right path forward. When male infertility is suspected and initial tests show absent or very low sperm counts, a testicular biopsy may provide crucial diagnostic information and potentially retrieve sperm for assisted reproductive procedures. This minimally invasive procedure helps determine whether the testes are producing sperm normally and can identify specific conditions affecting male fertility. In Singapore, testicular biopsies are performed by MOH-accredited urologists using established techniques to ensure accurate diagnosis while minimising discomfort and recovery time.
What is a Testicular Biopsy?
A testicular biopsy is a medical procedure that involves obtaining a small sample of testicular tissue for microscopic examination. This procedure serves two primary purposes: diagnosing the cause of male infertility and retrieving sperm for use in assisted reproductive techniques such as IVF (in-vitro fertilisation) or ICSI (intracytoplasmic sperm injection).
The procedure helps distinguish between obstructive azoospermia, where sperm production is normal but blocked from reaching the semen, and non-obstructive azoospermia, where sperm production is impaired or absent. During the biopsy, tissue samples are carefully extracted from one or both testicles through a small incision or needle aspiration. These samples are then examined by a pathologist to assess sperm production and identify any abnormalities in the testicular tissue structure.
Testicular biopsies are particularly valuable when semen analysis shows no sperm (azoospermia) or severely reduced sperm counts (oligospermia), and the cause cannot be determined through blood tests or physical examination alone. The procedure provides definitive information about testicular function and can guide treatment decisions for couples pursuing fertility treatment.
Who is a Suitable Candidate?
Ideal Candidates
- Men with azoospermia (no sperm in semen) requiring diagnosis of the underlying cause
- Couples planning IVF/ICSI who need sperm retrieval when no sperm is present in ejaculate
- Men with severe oligospermia where the cause needs clarification
- Patients with normal hormone levels but absent sperm, suggesting possible obstruction
- Men with previous vasectomy considering sperm retrieval for assisted reproduction
- Cases where genetic testing of testicular tissue is required
- Patients with suspected testicular cancer requiring tissue diagnosis
- Men with undescended testicles in childhood requiring fertility assessment
Contraindications
- Active infection in the genital area or urinary tract
- Bleeding disorders or current use of blood-thinning medications (requires medical review)
- Severe testicular atrophy where tissue sampling may be technically difficult
- Certain medical conditions that increase surgical risks
- Previous testicular surgery that may complicate the procedure
A thorough evaluation by a urologist is essential to determine if testicular biopsy is appropriate for your specific situation. Your medical history, physical examination findings, hormone levels, and genetic test results will all be considered when recommending this procedure.
Treatment Techniques & Approaches
Testicular Sperm Extraction (TESE)
TESE is an open surgical technique where a small incision is made in the scrotum to access the testicle directly. The surgeon makes a small cut in the testicular covering (tunica albuginea) and removes a small piece of testicular tissue. This technique allows for direct visualisation of the testicular tissue and enables the surgeon to select areas that appear most likely to contain sperm. TESE is often preferred when larger tissue samples are needed or when sperm retrieval for IVF is the primary goal.
Fine Needle Aspiration (FNA)
FNA involves using a thin needle to extract testicular tissue without making an incision. Under local anaesthesia, the needle is inserted directly through the scrotal skin into the testicle, and tissue is aspirated using gentle suction. This technique is less invasive than open biopsy and typically results in less post-procedure discomfort. FNA is suitable for diagnostic purposes and can also retrieve sperm, though the sample size is smaller than with TESE.
Microsurgical TESE (Micro-TESE)
Micro-TESE uses an operating microscope to identify areas of the testicle most likely to contain sperm. This technique allows for precise tissue extraction while preserving blood vessels and minimising damage to surrounding tissue. The microscopic magnification helps identify seminiferous tubules that appear larger and more opaque, which are more likely to contain sperm. This approach is particularly useful in cases of non-obstructive azoospermia where sperm production is limited.
Technology & Equipment Used
Modern testicular biopsy procedures utilise specialised microsurgical instruments, operating microscopes with high magnification capabilities, and established tissue preservation techniques. Ultrasound guidance may be used to identify optimal biopsy sites and avoid blood vessels. Specialised media and cryopreservation equipment ensure retrieved sperm remains viable for future use in assisted reproduction.
The Treatment Process
Pre-Treatment Preparation
Before your testicular biopsy, you’ll undergo blood tests to check for infections and assess blood clotting function. Your urologist will review your medications, and you may need to stop blood-thinning medications several days before the procedure. Arrange for someone to drive you home after the procedure, as you may experience some discomfort. On the day of the biopsy, shower with antibacterial soap and wear comfortable, supportive underwear. You’ll typically be asked to fast for 6-8 hours if sedation will be used.
During the Procedure
The procedure begins with positioning you comfortably on the examination table. The scrotal area is cleaned with antiseptic solution and draped with sterile covers. Local anaesthetic is injected into the scrotal skin and around the spermatic cord to numb the area completely. For open biopsy (TESE), a small incision of about 2-3cm is made in the scrotum. The testicle is gently delivered through the incision, and a small piece of tissue is removed. For needle biopsy (FNA), the needle is inserted directly through the numbed skin.
The tissue sample is immediately examined under a microscope if sperm retrieval is the goal, or preserved in special fixative for pathological examination. The entire procedure typically takes 15-30 minutes for a standard biopsy, or up to 2-3 hours for micro-TESE procedures. Most patients report feeling pressure but minimal pain during the procedure.
Immediate Post-Treatment
After the procedure, you’ll rest in the recovery area for 30-60 minutes. Ice packs are applied to reduce swelling and discomfort. Your vital signs will be monitored, and you’ll receive instructions for home care. Pain medication will be prescribed to manage any discomfort. The surgical site will be covered with a sterile dressing, and you’ll be advised to wear supportive underwear or a scrotal support. Most patients can go home the same day once they’re comfortable and any sedation effects have worn off.
Recovery & Aftercare
First 24-48 Hours
Apply ice packs to the scrotal area for 20 minutes every 2-3 hours while awake to minimise swelling. Take prescribed pain medication as directed, though many men find over-the-counter pain relievers sufficient. Keep the incision site clean and dry, avoiding showers for the first 24 hours. Rest with your scrotum elevated when lying down to reduce swelling. Light activities like walking are encouraged, but avoid strenuous movement, heavy lifting, or straining. Watch for signs of infection such as increasing pain, redness, fever, or unusual discharge.
First Week
Continue wearing supportive underwear to minimise discomfort and swelling. You may shower after 48 hours, gently patting the area dry afterwards. Avoid soaking in baths, swimming pools, or hot tubs until the incision has fully healed. Most men can return to desk work after 2-3 days, though jobs requiring physical labour may require a week off. Sexual activity should be avoided for at least one week or as advised by your urologist. Attend your follow-up appointment to check healing progress and receive biopsy results if not already discussed.
Long-term Recovery
Complete healing typically occurs within 2-3 weeks. Any non-dissolvable stitches will be removed at your follow-up appointment, usually 7-10 days post-procedure. Most men can resume all normal activities, including exercise and sexual activity, after 2-3 weeks. If sperm was successfully retrieved and frozen, you’ll receive information about storage and future use. Your urologist will discuss the biopsy results and their implications for your fertility treatment options. Regular follow-up may be recommended depending on the underlying condition identified.
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Benefits of Testicular Biopsy
Testicular biopsy provides definitive diagnosis of male infertility causes, enabling targeted treatment planning. For men with azoospermia, the procedure distinguishes between obstructive and non-obstructive causes, which fundamentally changes management approaches. When sperm is successfully retrieved, it can be used immediately for IVF/ICSI procedures or cryopreserved for future use, providing hope for biological parenthood even in severe male infertility cases.
The procedure offers valuable prognostic information about testicular function and sperm production potential. This helps couples make informed decisions about their fertility journey. For men with suspected testicular malignancy, biopsy provides crucial diagnostic information for cancer staging and treatment planning.
Testicular biopsy can identify specific conditions like maturation arrest or Sertoli cell-only syndrome, which may have implications for genetic counselling. The minimally invasive nature of modern biopsy techniques means most men experience minimal disruption to their daily lives while gaining essential information about their fertility status.
Risks & Potential Complications
Common Side Effects
Mild to moderate scrotal swelling and bruising are expected after testicular biopsy, typically resolving within 1-2 weeks. Most men experience some discomfort at the biopsy site, effectively managed with prescribed pain medication. A small amount of blood in the semen may occur for several weeks after the procedure, which is normal and resolves spontaneously. Temporary scrotal tenderness and sensitivity are common but gradually improve over the first week.
These side effects are generally well-tolerated and don’t require specific treatment beyond standard post-procedure care. Ice application, rest, and scrotal support significantly reduce these temporary effects.
Rare Complications
Infection at the biopsy site occurs in less than 1% of cases and is treated with antibiotics when identified early. Bleeding within the scrotum (haematoma) is uncommon but may require drainage if significant. Testicular atrophy or shrinkage is extremely rare when the procedure is performed by experienced surgeons using proper technique. Chronic testicular pain persisting beyond the normal recovery period affects a very small percentage of patients.
Your urologist takes multiple precautions to minimise these risks, including sterile technique, careful tissue handling, and appropriate patient selection. Choosing an experienced MOH-accredited urologist familiar with microsurgical techniques further reduces complication risks.
Cost Considerations
The cost of testicular biopsy in Singapore varies depending on several factors including the specific technique used, whether it’s performed for diagnosis alone or includes sperm retrieval and freezing, and the complexity of your case. Open biopsy (TESE) and needle aspiration (FNA) typically cost less than microsurgical procedures (micro-TESE) which require specialised equipment and longer operating time.
Additional costs may include pre-procedure tests, anaesthesia fees, histopathology examination, and sperm processing and storage if retrieval is successful. Some clinics offer package rates that include the procedure, initial consultation, and follow-up visits. The investment in accurate diagnosis and potential sperm retrieval often proves valuable for couples pursuing fertility treatment, as it provides crucial information for treatment planning.
During your consultation, your urologist will provide a detailed cost estimate based on your specific requirements and the recommended approach for your situation.
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Frequently Asked Questions
How long does a testicular biopsy procedure take to perform?
A standard testicular biopsy typically takes 15-30 minutes to complete. Needle aspiration (FNA) may be quicker, around 10-15 minutes, while microsurgical testicular sperm extraction (micro-TESE) can take 2-3 hours because of the detailed microscopic examination required. The total time at the clinic is usually 2-3 hours, including preparation and recovery time.
Will testicular biopsy affect my hormone production or sexual function?
Testicular biopsy removes only a tiny amount of tissue and does not significantly impact hormone production or sexual function. The testicles contain millions of cells, and the small sample taken for biopsy represents less than 1% of total testicular tissue. Testosterone production and sexual function remain normal after the procedure. Most men can resume sexual activity within 1-2 weeks once healing is complete.
What is the success rate of finding sperm through testicular biopsy?
Success rates vary significantly depending on the underlying cause of infertility. In men with obstructive azoospermia (blocked sperm transport), sperm retrieval success approaches 90-100%. For non-obstructive azoospermia (impaired sperm production), success rates range from 40-60% depending on the specific condition. Factors like hormone levels, testicular size, and genetic factors influence the likelihood of finding sperm.
Can testicular biopsy be repeated if the first attempt doesn’t find sperm?
Yes, testicular biopsy can be repeated if necessary. Some men may benefit from a second attempt, particularly if the first biopsy was limited in scope or if micro-TESE wasn’t initially performed. Your urologist will assess whether repeat biopsy is advisable based on your initial results, hormone levels, and overall clinical picture. Modern techniques like micro-TESE may offer improved success rates in repeat procedures.
How soon after testicular biopsy can retrieved sperm be used for IVF?
Retrieved sperm can be used immediately for IVF/ICSI if your partner’s egg retrieval is coordinated with the biopsy procedure. More commonly, sperm is frozen (cryopreserved) for future use, allowing flexibility in timing IVF cycles. Frozen sperm maintains good viability and can be thawed when needed. This approach also allows multiple IVF attempts from a single biopsy procedure.
Is testicular biopsy painful?
Most men experience minimal pain during the procedure because of effective local anaesthesia. You may feel initial discomfort from the anaesthetic injection, followed by pressure sensations during tissue extraction, but sharp pain is uncommon. Post-procedure discomfort is typically mild to moderate and well-controlled with prescribed pain medication. Most patients report that the procedure is less uncomfortable than anticipated.
What’s the difference between diagnostic biopsy and therapeutic sperm retrieval?
Diagnostic biopsy focuses on obtaining tissue to determine the cause of infertility and assess sperm production capability. Therapeutic sperm retrieval aims to collect viable sperm for use in assisted reproduction. Often, both goals are accomplished in a single procedure. The tissue sample provides diagnostic information while any retrieved sperm is processed and preserved for fertility treatment.
How long do I need to wait for biopsy results?
Preliminary results about sperm presence may be available immediately if on-site examination is performed. Complete histopathology results typically take 5-7 working days. These detailed results provide information about testicular architecture, sperm production stages, and any abnormalities present. Your urologist will schedule a follow-up appointment to discuss results and treatment implications comprehensively.
Conclusion
Testicular biopsy represents an important diagnostic and therapeutic tool for men facing fertility challenges. This procedure provides definitive answers about sperm production capability and can successfully retrieve sperm for assisted reproduction even in cases of severe male infertility. With modern techniques and experienced surgeons, testicular biopsy is a safe, well-tolerated procedure that offers valuable information for treatment planning.
Understanding the cause of male infertility through testicular biopsy empowers couples to make informed decisions about their fertility journey. Whether the goal is diagnosis, sperm retrieval, or both, this procedure often provides the clarity needed to move forward with appropriate treatment options.
Dr. Lie Kwok Ying
BA MB BChir (Cantab)|MRCS (Edin)|MMEd (Surg)|FRCS (Glasg)(Urol)|FAMS
Dr. Lie Kwok Ying is a Senior Consultant Urologist and pioneered the use of HoLEP (Holmium Enucleation of Prostate) for benign prostatic hyperplasia (BPH) in Singapore.
He graduated from Queens’ College in Cambridge University with triple First Class Honours and subsequently qualified in 2001 with degrees in Medicine and Surgery.
Clinical Interests in Urology
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