Microsurgical testicular sperm extraction (microTESE)

Overview

Microsurgical testicular sperm extraction (microTESE), also known as microdissection testicular sperm extraction, is a surgical treatment for male infertility. This procedure involves extracting sperm directly from the testicular tissue in the testes to obtain the highest quality sperm and a sufficient quantity to fertilize a healthy female egg, while minimizing damage to the reproductive organs.

Reasons for undergoing the procedure

Healthcare providers often recommend microTESE to treat male infertility caused by the absence of sperm in semen (azoospermia). This procedure is suggested if you wish to have a biological child but are unable to naturally produce or release sufficient healthy sperm to fertilize an egg cell.

Risk

As with any procedure, microTESE involves potential risks, such as:

• Pain
• Infection
• Complications from anesthesia
• Severe bleeding
• In rare cases, permanent damage to the testicles

However, with microTESE, the known main risk is that there may not be enough healthy sperm in the tissue samples to fertilize an egg.

Before the procedure

Prior microTESE, the healthcare provider may provide specific instructions, such as:

• Take any required medications with a small sip of water
• Avoid food and beverages after midnight before the procedure
• Stopping certain medications that may increase bleeding risk

Generally, before the microTESE procedure, the healthcare provider will review one’s health history, conduct a physical examination, and check their vital signs, including temperature, pulse, and blood pressure.

It is also important that the healthcare provider is made aware of all allergies one has.

During the procedure

MicroTESE procedure usually takes less than two hours. A high-powered microscope is used to search for sperm in the tissue sample. If sperm is found, it can be used immediately to fertilize an egg or frozen for later use in invitro fertilization (IVF).

MicroTESE is typically performed under general anesthesia. Once the patient is unconscious, the procedure proceeds as follows:

• Make a single incision in the center of the scrotum using a scalpel
• Testicular biopsy, or to create several small cuts in the testicle to extract a small tissue sample
• If needed, obtain a tissue sample from the other testicle as well
• Send the tissue samples to a laboratory for analysis.

After the procedure

After the microTESE, the laboratory may find healthy sperm right away or it might take a day for results. The healthcare provider will keep the patient informed about what to expect.

Once the tissue samples are collected, the anesthesia will be stopped, and the incisions will be closed with dissolvable stitches. One may wake up feeling groggy but will be monitored for health and pain management.

Outcome

The initial days after the procedure might be quite painful, but most individuals recover fully within a few weeks. Those with physically demanding jobs might require additional time off.

During the recovery period, the following measures are often advised:

• Use an ice pack to reduce swelling
• Take over-the-counter pain relievers like NSAIDs or acetaminophen
• If necessary, use prescribed stronger pain medication
• Avoid heavy exercise and lifting for a few days

It’s also crucial to monitor for potential complications, including:

• Signs of sepsis
• Symptoms of infection, such as fever, chills, or unusual colors (red, purple, brown, or black) or pus around the incision
• Intense pain
• Excessive bleeding around the incision
• Blood in the urine

The main benefit of a microTESE procedure is enhancing the likelihood of having a biological child, with healthy sperm being retrieved in up to 60% of cases, depending on the underlying cause of azoospermia.