Azoospermia is a condition in which a man's ejaculate contains no sperm. It is diagnosed in approximately 5% of men seeking infertility treatment. Depending on the cause, azoospermia is classified into two types:

• Obstructive (excretory) — sperm is produced, but does not reach the ejaculate due to obstruction in the reproductive ducts.
• Non-obstructive — associated with impaired spermatogenesis.

A testicular biopsy is both a diagnostic and therapeutic procedure that involves retrieving tissue from the testicle or epididymis to search for sperm. It is a key method for obtaining sperm in azoospermia cases for use in assisted reproductive technologies (ART), such as IVF with ICSI (intracytoplasmic sperm injection).

Why Choose the Vitromed Clinic

Vitromed Clinic offers optimal conditions for all existing types of testicular biopsy — from minimally invasive to high-precision microsurgical techniques:

• Performed by an experienced urologist-andrologist skilled in modern techniques
• Equipped with advanced tools, including the Wallach surgical microscope (USA)
• An embryologist is present to immediately analyze the sample under a microscope
• If sperm is found, the material can be cryopreserved or used immediately for fertilization (if egg retrieval is done in parallel from the partner)

Biopsy Methods at Vitromed
Percutaneous Aspiration Techniques
PESA (Percutaneous Epididymal Sperm Aspiration)  — Needle aspiration of sperm from the epididymis.

• Performed under local anesthesia
• Simple and quick (up to 15 minutes)
• Used in obstructive azoospermia

TESA (Testicular Sperm Aspiration)  — Needle biopsy of testicular tissue

• Indicated for obstructive azoospermia and infertility diagnosis
• Low invasiveness, fast recovery
• Main drawback: blind tissue collection without visual control

Open Surgical Methods

TESE (Testicular Sperm Extraction) — Open testicular biopsy

• Performed under local anesthesia through a scrotal incision
• Allows for larger tissue sampling and histological analysis
• Used in non-obstructive azoospermia
• Bilateral multifocal TESE yields sperm in ~65% of cases

MESA (Microsurgical Epididymal Sperm Aspiration) — Microsurgical epididymal aspiration

• Conducted under magnification (microscope), increasing accuracy and reducing trauma
• Used in obstructive azoospermia, especially after vasectomy
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Micro-TESE – Gold Standard for Non-Obstructive Azoospermia

Micro-TESE (Microdissection Testicular Sperm Extraction) — A microsurgical biopsy of the testicle involving:

• Use of a high-powered surgical microscope to find seminiferous tubules with preserved spermatogenesis
• Minimal tissue damage
• Higher chances of finding sperm, even after failed TESE (50–70%)
• Considered the most effective method for non-obstructive azoospermia

Advantages of Micro-TESE:

• Minimal tissue trauma
• Accurate visualization of blood vessels and testicular structure
• High success rate with low risks
• Can be done on the same day as egg retrieval or in advance with cryopreservation

After the Biopsy

• If sperm is found, it is either cryopreserved or used immediately for fertilization
• If not, the sample may be analyzed for spermatids, which can enable paternity using experimental techniques like ROSI (round spermatid injection)
• Recovery is fast — most patients return home the same day

Conclusion

Vitromed Clinic provides a full range of diagnostic and therapeutic services for male infertility, including the most advanced testicular biopsy methods. We offer:

• A personalized approach
• High procedural success rates
• Safety and confidentiality

We help men become fathers — even in the most challenging cases.

Trust the professionals at Vitromed.