TESTICULAR SPERM EXTRACTION: TESE & microTESE

Testicular sperm extraction (TESE) and microdissection TESE (microTESE) are advanced procedures in reproductive medicine designed to retrieve sperm directly from the testes in men with severe male factor infertility. These techniques are particularly valuable for men with non-obstructive azoospermia (NOA), where sperm production is impaired and no sperm is present in the ejaculate. In this post, I will explain the differences between the two procedures, why sperm banking is an integral part of the procedure, and discuss realistic expectations.

TESE: Testicular Sperm Extraction

TESE is a procedure in which a small sample of testicular tissue is surgically removed to extract sperm. Here’s a closer look at its key aspects:

Procedure: TESE involves making an incision in the scrotum to access the testicle. A small piece of testicular tissue is excised and then processed in the laboratory to extract viable sperm cells.
Indications: TESE is primarily indicated for men with NOA, especially those who have failed to retrieve sperm through less invasive methods like percutaneous epididymal sperm aspiration (PESA) or testicular sperm aspiration (TESA).
Expectations: The success rate of TESE varies. In general, the chances of finding sperm range from 30% to 90%, depending on the underlying condition. Sperm retrieval success rates are higher in men with obstruction, such as those after a vasectomy or having congenital bilateral absence of the vas deferens (CBAVD) or men with focal areas of sperm production, compared to those with uniform testicular failure.

microTESE: Microdissection Testicular Sperm Extraction

microTESE is a more refined and advanced technique that uses an operating microscope to locate areas of sperm production within the testicle. This method offers several advantages over conventional TESE:

Procedure: microTESE is performed under an operating microscope, which allows the surgeon to identify and selectively remove the most promising areas of testicular tissue. The microscopic magnification helps in distinguishing between healthy and damaged tissue, thereby increasing the likelihood of finding viable sperm.
Indications: microTESE is especially indicated for men with severe NOA, where sperm production is extremely limited. It is often recommended when initial attempts using TESE or other methods have failed.
Expectations: The success rate of microTESE is generally higher than that of TESE, with sperm retrieval rates reported to be between 40% and 63%. The precision of microTESE helps in maximizing the chances of finding sperm while minimizing damage to the testicular tissue.

Banking of Tissue and Sperm: A Crucial Step

Regardless of the surgical method used, banking the retrieved sperm and testicular tissue is essential for future fertility treatments. Here’s why:

Future Use: Cryopreservation of sperm allows for multiple attempts at in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) without the need for repeated surgical procedures.
Maximizing Chances: Given the variability in sperm retrieval success, banking any viable sperm found provides a valuable resource for future fertility treatments.
Cost-Effective: Banking reduces the need for additional surgical procedures, which can be costly and invasive.

The sperm bank you choose must document the quality of the sperm present in the sample and provide you and your fertility doctors with a report and images of the sperm present. This information, particularly the images of the sperm present, provides crucial information for the technical staff preparing the testicular specimens for use in IVF (in vitro fertilization). These images provide insight into the challenges present and the time and staff that will be required for preparing the specimens for use in an IVF procedure, and in this way, significantly increase the probability of a successful outcome.

Realistic Expectations

While TESE and microTESE offer hope for men with severe male infertility, it is important to set realistic expectations:

Variable Success Rates: Success rates can vary significantly based on individual conditions, including the underlying cause of NOA, testicular health, and prior treatments.
Multiple Procedures: Sometimes, multiple procedures may be necessary to retrieve sufficient sperm for IVF/ICSI.
Collaboration with Specialists: Working with experienced reproductive urologists and fertility specialists is crucial for optimizing outcomes.

Conclusion

TESE and microTESE represent significant advancements in the field of male infertility, offering hope to men who previously had limited options. While these procedures come with their challenges and variable success rates, the ability to bank sperm and tissue provides a pathway to potential parenthood. For couples facing severe male infertility, understanding these options and setting realistic expectations can be an empowering step toward achieving their dreams of having a family.

For additional information, please visit our website or contact us by email or phone (516-487-2700)