Microsurgical testicular sperm extraction – microTESE

Microsurgical testicular sperm extraction – microTESE

MicroTESE is an advanced modification of testicular biopsy (TESE). This method is used to treat infertility due to azoospermia – a condition manifested by absence of sperm in the semen. Azoospermia affects approximately 1% of all men, and contributes to 5–10% of male infertility cases.

What causes azoospermia and how is it treated?

Lack of spermatozoa in the semen – Testicular biopsy using microTESE

The effectiveness of microTESE is superior to that of a standard TESE method of collecting sperm. It is a microsurgical procedure that offers a hope of fatherhood to men in situations previously considered hopeless. Thanks to microTESE, men with azoospermia have a chance to be biological fathers.

What is microTESE?

MicroTESE is a method of taking a biopsy from the testicles with the use of a surgical microscope. It allows to see the seminiferous tubules and localise the areas where even a small number of spermatozoa is produced.

The testicle is accessed through a cut in the scrotum. Next, the surgeon uses a microscope to find a potential site of spermatozoa production in the seminiferous tubules in the testicles, and extracts them. Embryologists find in the collected tissue the sperm cells capable of fertilising an egg using the in vitro method with intracytoplasmic sperm injection. During the procedure the patient is under general anaesthesia.

What is the effectiveness of microTESE?

In up to 80% of men diagnosed with azoospermia, the foci of sperm production (spermatogenesis) can be found in their testicles. Standard testicular biopsy (TESE) enables a successful detection of these sites and their use for in vitro fertilisation (IVF) in 40–50% of men. MicroTESE allows to detect additional areas of sperm production. The likelihood of success of this procedure is even 1.5 times higher than in the case of the standard TESE.

Who performs microTESE?

Microsurgery requires high qualifications and unique precision. Therefore, microTESE procedures are performed by experts who are perfectly familiar with the structure and characteristics of testicles, as well as with the apparatus used for microsurgeries.

Male infertility treatment using microTESE – indications

MicroTESE should be considered in patients:

  • with non-obstructive (secretory) azoospermia associated with a low likelihood of finding sperm cells in the testicles (high serum FSH concentrations, small testicular volume)
  • in whom spermatozoa were not found in a standards TESE procedure.

Azoospermia – does it eliminate the chance of having children?

There are two types of azoospermia: obstructive and secretory (non-obstructive). Obstructive azoospermia is caused by a blockage of the routes that transport the sperm from the testicles. The likelihood of finding sperm cells in the testicles is high. In non-obstructive (secretory) azoospermia sperm production in the testicles is impaired or absent. In this case the chances of finding spermatozoa in the testicles are much lower.

Azoospermia – diagnosis

Azoospermia is diagnosed based on two independent sperm analyses. If the results of both tests demonstrate an absence of sperm cells in the semen, the preliminary diagnosis is confirmed. However, the confirmation is preceded by a detailed medical interview with the patient, including previous diseases (e.g. mumps). The visit includes other tests: andrological, hormonal and other, individually selected, additional tests.

Their goal is to determine if sperm production might be preserved.

Azoospermia – previous treatment involving the TESE method

Previously, to help a man with azoospermia father a biological child, spermatozoa were extracted from the testicles using the TESE method. It consists of a so-called ‘blind’ testicular biopsy, as the classical TESE procedure involves a random extraction of sample material for testing. If sperm cells are found in the collected samples, they may be frozen or used immediately for the fertilisation of the partner’s egg.

Otherwise, it is still possible that spermatogenesis (the process of sperm production) takes place in other parts of the testicles. Further biopsies may be performed. However, the chances of finding sperm cells decrease with every procedure. Moreover, each biopsy for sperm extraction is troublesome for the patient.

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