MicroTESE Instead of Biopsy
For men with nonobstructive azoospermia, we do not recommend fine needle aspiration or biopsy before to microTESE because many studies have shown that micro TESE yields the highest sperm retrieval rate and causes the least amount of damage to the testis. If all of the sperm from the first micro TESE are used in in-vitro fertilization attempts, repeat micro TESE procedures are possible. However, if the first micro TESE is unsuccessful, repeat procedures result in only a 7–10% success rate.
What Makes MicroTESE Successful?
For microTESE to be successful, you need to have a skilful surgeon and an excellent andrology technologist searching for sperm. At the time of the micro TESE procedure, an andrology lab technician is assigned to the operating room to analyse the seminiferous tubules for sperm. If sperm are found during microTESE, they are extracted and frozen for future reproductive treatment, such as in-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI).
(Existing data demonstrates that frozen sperm may perform even better than fresh sperm for in-vitro fertilization.)**
The worst part of micro TESE is really the idea of the surgery. The procedure is performed through a very small (3–4 cm) incision in the midline of the scrotum. The patient is under general anaesthetic (completely asleep) before we start the surgery. We open the testicles through this incision and look under a high power, operating microscope (at 30–40X magnification) for seminiferous tubules that are swollen and contain sperm.
Once we have taken a sample of sperm from one side’s tubules, or after we have sampled all the tissue, we will stop any bleeding and close the testis with a very fine suture under the operating microscope. We will repeat this procedure on the opposite side.
After collecting the samples, we close all the layers of tissue that we opened to enter the scrotum. The patient will be left with a suture that will eventually dissolve leaving little or no scar. The sample tissue is then passed to an andrology technologist who will examine it under a standard microscope to look for the presence of sperm.
Most men are surprised by the minimal amount of pain they have after this surgery. The scrotum is one of the fastest healing parts of the body and the multi-layered closure technique we use helps to ensure that men do not have infections or bleeding after the surgery.
Most men use an ice pack for the first 24 hours after the surgery and then forget to take the pain medications they are sent home with. We ask that men avoid sex, masturbation, or vigorous exercise for 10 days after the surgery.
We will notify the patient by phone with the results of the procedure the day after the surgery. It typically takes 10–14 hours of searching for sperm under the microscope to determine if any sperm were found. Extracted sperm will be frozen in liquid nitrogen and can be used for in-vitro fertilization by your reproductive endocrinologist of choice.
TESA or TESE: Which Is Better for Sperm Extraction?
Research shows that there is a better chance of cryopreservation of sperm obtained by TESE rather than TESA. The importance of this is that such cryopreserved sperm can be used in subsequent cycles rather than the patient having to go through another TESE or TESA procedure.