Testicular Sperm Extraction: TESE Uses and Procedure

Lab technician examining TESE sample under microscope.

What is Testicular Sperm Extraction?

Testicular Sperm Extraction, or TESE, is a procedure where sperm cells are taken directly from the testicles. TESE is performed when pregnancy is desired but not possible without medical assistance.

During the TESE procedure, tissue samples are taken from the testicles and sent to a sperm bank for analysis. If viable sperm are detected, the tissue can then be frozen and stored for later use.

Some reasons why this procedure may be necessary include:

  • Non-Obstructive Azoospermia – The testicles don’t produce enough sperm for successful pregnancy.
  • Obstructive Azoospermia – A blockage of the vas deferens exists that prevents the sperm from mixing with the semen.
  • Retrograde Ejaculation – The semen goes into the bladder instead of exiting the penis.
  • Anejaculation – An inability to ejaculate.
  • Men who have had a vasectomy
  • In vitro fertilization failure due to poor sperm quality

In these situations, sperm can be collected directly from the man’s reproductive tract where it can be later used for IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection).

TESE Procedure

The TESE procedure itself takes about 15 minutes. It is usually performed on an outpatient basis at a doctor’s office with numbing medication. There is also the option to use nitrous oxide, which is the same gas used by dentists to help anxious patients relax.

You can also opt to have the procedure done in an operating room under general anesthesia, but most patients prefer to have it done at the doctor’s office. Either way, it’s an outpatient procedure, so you can expect to return home that day.

A TESE is essentially a biopsy of the testicle. It involves taking a small sample of tissue from the testicle that can be used for in vitro fertilization (IVF). However, TESE does not remove enough tissue for IUI (intrauterine fertilization), as that procedure requires a much higher concentration of sperm.

Depending on the reason for your infertility, success rates can vary greatly. Your doctor will be able to give you a more accurate estimate during your consultation.

MicroTESE

Microsurgical testicular sperm extraction, also referred to as microTESE, is a specialized type of TESE. This procedure is used if your semen analysis reveals no sperm because of a problem with the testicles producing sperm. It’s done by opening the testicle and using an operating microscope to locate pockets of sperm.

This type of procedure can take as long as three hours to perform. It can be done in a doctor’s office using the same numbing medication and light sedation as with standard TESE, or in the operating room using general anesthesia.

Regardless, you can expect to go home that day. Any sperm that is located will be used for in vitro fertilization. Depending on the factors discussed at your consultation, success rates for microTESE can vary widely, from 20-60%.

During a micro-TESE, the doctor will look under an operating microscope for pockets containing sperm. The surgeon will take samples of those areas and examine them under a bench microscope to see if any sperm are present.

This process will continue over a prolonged period until sperm can be found. If the surgeon is unable to find sperm on one side, he or she will typically go to the other side to see if any sperm is there.

Although rare, both TESE and microTESE have risks. These risks occur in less than 5% of cases, but can include:

  • Infection of the testicle, or the incision site
  • Bleeding that results in prolonged swelling and bruising of the scrotum.
  • Chronic pain in the testicle
  • A decrease in testosterone production
  • A decrease in the testicle’s size.
  • An interference in blood flow to the testicle. If this occurs it is likely to affect future sperm and/or testosterone production

What Are the Differences Between TESE and MicroTESE?

TESE is typically indicated for Men who:

  • Have had a history of vasectomy.
  • Have not been able to conceive with IVF due to poor sperm quality obtained from a semen sample.
  • Men showing no sperm on semen analysis (azoospermia).

Standard TESE is much less invasive than microTESE and is also less expensive.

MicroTESE, on the other hand, is used specifically for men who’s semen analysis reveals no sperm due to impaired sperm production – a condition is known as non-obstructive Azoospermia. This is different from when a blockage causes no sperm to show on semen analysis, a condition is referred to as obstructive azoospermia.

A microTESE procedure is more invasive and can cause a disruption of blood flow to the testicle. Although it is somewhat more expensive, because it can still be done in an office setting it’s cost is comparable to that of TESE.

Using this procedure, men with nonobstructive azoospermia are 1 1/2 times more likely to have viable sperm retrieved compared to TESE.

Recovery

No matter which procedure you have, the recovery process is the same. Your results will typically be ready within 24 hours, and you will be told whether or not sperm was able to be retrieved.

All skin sutures will be dissolvable, so you don’t have to return to the doctor to have any stitches removed. You can normally remove the bandages, resume showering, and return to work within 24 hours.

Avoid engaging in strenuous activity or lifting more than 10 pounds for at least 2 weeks. You should be able to resume sexual activity within one week.

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