When azoospermia (absence of sperm in semen) is seen in at least two spermogram tests, the doctor examines the testicles and the level of FSH and LH hormones in the blood is measured. If the levels of these hormones are normal and the testicles are in a favorable condition during the examination, a testicular biopsy (TESE) is performed to determine whether the azoospermia is related to the production disorder in the testicles or is an obstruction
Also, sometimes, if there is evidence of sperm production disorder in the testicles, such as an increase in FSH or small testicles in the examination, a testicular sampling (TESE) is performed to determine whether there is sperm in the testicular tissue for ICSI. If there is suitable sperm and with the discretion of the doctor, the testicular tissue is frozen and stored to be used if necessary. For the TESE operation, a slit is made on the skin of the scrotum (in the operating room) and with the help of a surgical microscope, samples are taken from the appropriate points of the testicular tissue. The sample is sent to embryology for cytology examination and to the laboratory for pathology examination. The gap on the testicular capsule and the layers of the scrotum are also repaired with stitches.