Men with little or no sperm in the ejaculate may have an intrinsic testicular production problem or an obstruction to the outflow of sperm from the testicle. Hormonal evaluation through blood tests can suggest the cause; however, a testicular aspiration or core biopsy is a diagnostic tool that helps distinguish the two as well as inform the next steps for a man’s reproductive course. A local anesthetic is used to numb nerves of the testicle and a small aspirating syringe is used to obtain a seminiferous tubule from the testicle.
If the male has no sperm in the ejaculate, but sperm is found on the aspiration, he may undergo a testicular sperm extraction (TESE) at the time of his partner’s egg extraction or separately and cryopreserve the sperm for future use. Men with epididymal obstruction such as congenital cysts and sperm found on aspiration may be considered for reconstruction to bypass the obstruction.
If no sperm is found on the aspiration, a more in-depth search through the seminiferous tubules is warranted with the use of a surgical microscope in the operating room.
Testicular Sperm Aspiration / Testicular Core Biopsy Resources:
- Brief TESA Procedure Descriptions
- Sperm Retrieval and Diagnosis Techniques from the Urology Care Foundation