Overview

What Is MicroTESE?

What Is MicroTESE?

Non-obstructive azoospermia is when a man has no sperm in his semen because his body produces abnormal sperm. It’s a very common cause of male infertility. If you have non-obstructive azoospermia, doctors will usually recommend a procedure called microsurgical testicular sperm extraction (microTESE) in these cases:

  • If a man has an adequate level of testosterone in sperm test results*
  • If a man remains azoospermic even though he’s received treatment and his testosterone levels have been normal for at least four months

Doctors are able to find sperm approximately 70 percent of the time during microTESE procedures.

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MicroTESE Instead of Biopsy

For men with non-obstructive azoospermia, we do not recommend having fine needle aspiration or biopsy before microTESE. Many studies have shown that microTESE yields the highest sperm retrieval rate and causes the least amount of damage to the testis.

If you plan on using all of your sperm for IVF, you may need to have more than one microTESE procedure.

Sometimes doctor can’t find or extract sperm during the microTESE procedure. If this happens and you choose to have microTESE again, the chances of your doctor successfully finding sperm are only 7 to ten percent.

MicroTESE: Effect of Prior Biopsy on Sperm Retrieval

This chart shows why we don’t recommend performing mapping biopsies before microTESE. The graph in this figure shows the success of microTESE in men with non-obstructive azoospermia who have undergone 0, 1–2, or 3–4 prior testis biopsies attempting to find sperm. During microTESE procedures, doctors are able to find sperm in 56 percent of men who haven’t had a prior biopsy. Doctors find sperm in only 51 percent of men who’ve had 1–2 biopsies. For men who’ve had three to four biopsies, doctors find sperm in only 23 percent of men.

Put another way, if we performed a biopsy before microTESE and used it to determine whether or not to choose microTESE, we would not find sperm in half of the men where sperm could be obtained through microTESE.

 

What Makes MicroTESE Successful?

For microTESE to be successful, you need to have a skillful surgeon and an excellent andrology technologist searching for sperm. During your microTESE procedure, an andrology lab technician will be in the operating room to analyze your seminiferous tubules for sperm. If the technician finds sperm during your microTESE, your sperm will be extracted and frozen so they can be used in future reproductive treatments, like in-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI).

Current data shows that frozen sperm may perform even better than fresh sperm during IVF (in-vitro fertilization).**

 

Procedure

For most men, the worst part of microTESE is the idea of having surgery. To perform the procedure, your doctor will make a very small (3–4 cm) incision (or cut) in the midline of the scrotum. You will be under general anesthesia (completely asleep) before we start the surgery. Your doctor will open your testicles through this incision and look under a high power operating microscope (at 30–40X magnification) for seminiferous tubules that are swollen and may contain sperm. Your body has two sets of seminiferous tubules—one on the right side and one on the left side.

Next, we’ll take a tissue sample from one side’s tubules. Then, we’ll stop any bleeding and close the testis with very fine stitches using the operating microscope. Well repeat this procedure on the opposite side.

After collecting tissue samples, we close all the layers of tissue that we opened in order to enter your scrotum. You will have a suture that will eventually dissolve on its own and will leave little or no scarring. We will then give your tissue sample to our andrology technologist who will examine it under a standard microscope to look and see if it has any sperm.

Post-Surgery/MicroTESE Recovery

Most men are surprised by how little pain they have after this surgery. The scrotum is one of the fastest healing parts of the body. The multi-layered closure technique we use helps to make sure that men don’t 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 men to avoid sex, masturbation, or vigorous exercise for 10 days after the surgery.

We will call you the day after your surgery to let you know if we found any sperm. It usually takes 10–14 hours of searching for sperm under the microscope to determine if any sperm were found. If our technologist did find sperm in your tissues, he will extracted the sperm and then freeze it in liquid nitrogen. You can then use your sperm for IVF (in-vitro fertilization).

What Is Testicular Sperm Extraction (TESE)?

TESE or testicular sperm extraction is a simplified type of microTESE surgery. Doctors use this procedure in men who have developed obstructive azoospermia after medical treatments like vasectomies. TESE works similarly to the microTESE procedure, but TESE can be performed in your doctor’s office under local anesthesia.

TESE Procedure

To perform this procedure, we use a very small needle to completely numb your testicle and the skin around it. We then make a very small incision (cut) inside your scrotum so we can extract a small amount of sperm from your testicle. We can’t use this procedure for men who have non-obstructive azoospermia because TESE doesn’t use as much tissue as the microTESE procedure does.

*Note: this is very different from the total testosterone that many labs check

**Please note that any sperm we find during these procedures must be used for IVF (in-vitro fertilization). This is because sperm inside your testis hasn’t learned how to swim yet, so it can’t fertilize an egg if it’s placed inside the uterus.