In the open testicular biopsy, a small incision is made through the skin and a sample of testicular tissue is removed from one or both testicles. There is also a puncture biopsy, in which the testicle sample is taken, using a special needle that does not require incisions in the skin. It can be done under local anesthesia or sedation.

This type of procedure is indicated when there are no sperm in the ejaculate due to various situations (infections, post-vasectomy, absence of vas deferens, unknown cause among others).