The Basics
Microsurgical Testicular Sperm Extraction (MicroTESE) is a specialized surgical procedure for men with non-obstructive azoospermia (absence of sperm in the ejaculate due to impaired production). It involves using a high-powered microscope to locate and extract sperm from small, viable areas within the testicles for use in an IVF/ICSI procedure.
Who is a Candidate?
MicroTESE is primarily for men diagnosed with non-obstructive azoospermia, including those with conditions such as:
- Genetic disorders like Klinefelter syndrome or specific Y-chromosome microdeletions.
- History of chemotherapy or radiation treatments for cancer.
- Developmental issues like undescended testicles (cryptorchidism).
- Cases where prior, less effective sperm retrieval methods (conventional TESE, TESA) have failed.
A thorough evaluation, including physical exams, hormone levels (FSH, testosterone), and genetic testing, will determine if you are a suitable candidate.
The Procedure
The procedure is typically performed as a day-case surgery under general anesthesia.
- Access: A small incision is made in the middle of the scrotum to access the testicle.
- Microscopic Search: A urologist uses a high-powered surgical microscope to examine the seminiferous tubules (sperm-producing tubes) inside the testicle. The surgeon looks for tubules that appear larger and opaque, as these are more likely to contain sperm.
- Tissue Extraction: Small tissue samples from promising areas are carefully removed.
- Lab Analysis: An embryologist, present in the operating room or adjacent lab, immediately examines the tissue under a more powerful microscope to find viable sperm.
- Closure and Storage: If sperm are found, they are collected and either used immediately to fertilize a partner’s egg (fresh cycle) or frozen for future use (cryopreservation). The incisions are closed with dissolvable stitches.
Recovery and Aftercare
Recovery is usually quick, with most men returning to light activity within a few days.
- Pain Management: Mild discomfort, swelling, and bruising are common and can be managed with prescribed pain medication and intermittent use of ice packs for the first 24 hours.
- Activity Restrictions: Wear a scrotal support (jockstrap) for comfort for up to two weeks. Avoid heavy lifting, strenuous exercise, and sexual activity (including masturbation) for one to two weeks, or as advised by your doctor.
- Hygiene: You can usually shower 48 hours after surgery, but avoid baths or submerging the incision in water until it is fully healed.
Potential Risks and Success Rates
MicroTESE is a low-risk procedure, but potential complications include:
- Bleeding or hematoma formation.
- Infection at the incision site.
- Temporary pain or discomfort.
- A rare risk of damage or atrophy to the testicle.
The primary risk is the inability to find sperm. Success rates of Micro-TESE (sperm retrieval rates) typically range from 40% to 60% at experienced centers, depending on the underlying cause of infertility and the surgeon’s expertise. If the procedure fails the first time, it may be possible to repeat it after 6-12 months.
