Sperm Extraction with Micro-TESE: How Does It Work?


Microscopic testicular sperm extraction (microTESE) stands at the forefront of male infertility treatment, offering a beacon of hope to couples grappling with male factor infertility, notably non-obstructive azoospermia. This state-of-the-art procedure represents a paradigm shift in assisted reproductive technologies, presenting a pathway for couples to realize their dreams of parenthood through innovative methods like IVF.

The microTESE procedure employs sophisticated surgical microscopes to meticulously identify and extract small clusters of sperm directly from the testicles. Unlike conventional sperm retrieval methods such as testicular sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA), microsurgical sperm collection through microTESE precisely targets specific areas within the testicular tissue where sperm are most likely to be found, enhancing the chances of successful extraction.

In instances where no sperm are detected following a TESE procedure, the prospects for conceiving a biological child may seem daunting. However, microTESE offers a ray of hope by delving deeper into the testicular tissue to locate viable sperm, thus expanding the possibilities for fertility treatment success.

Navigating through the intricacies of microTESE recovery and its associated benefits and side effects, this article delves into the nuances of this groundbreaking procedure, shedding light on its success rates and offering insights into its transformative impact on male infertility treatment.

Micro-TESE Surgery Procedure

What Is a Micro-tese (Microscopic Testicular Sperm Extraction)?

Micro-TESE, or Microscopic Testicular Sperm Extraction, is a surgical procedure used to retrieve sperm from the testicles of men with non-obstructive azoospermia (NOA). This procedure is performed under a microscope, allowing the surgeon to identify and extract small amounts of sperm from the testicular tissue. This sperm then is used for assisted reproductive techniques such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) to help a couple conceive.

Micro-TESE is considered to be a more advanced and effective technique for retrieving sperm compared to traditional TESE, as it allows for a more precise and targeted extraction of sperm, increasing the chances of finding viable sperm for use in assisted reproductive technologies such as IVF. 

How Does Micro-TESE Procedure Done?

As previously noted, micro-TESE is a valuable option for men with NOA-related infertility who are hoping to conceive with their wife or partner. 

During the microscopic testicular sperm extraction (micro-TESE) procedure, the patient is typically placed under general anesthesia. The surgeon then makes a small 1- to 2-cm incision in the scrotum to access the testicles. 

Using a high-powered microscope (with up to 20x magnification), the surgeon carefully examines the testicular tissue to locate dilated seminiferous tubules that more likely contain sperm. These areas are then removed and sent to the laboratory to be examined for the presence of sperm.

The surgeon continues to examine all areas of the testicular tissue to extract viable sperm. Once the sperm are collected, the incision is closed, and the patient is allowed to recover from the anesthesia.

The extracted sperm will be frozen to be used for assisted reproductive techniques such as in vitro fertilization (IVF) or intracytoplasmic sperm injection.

Fortunately, the freezing procedure does not affect sperm cells negatively. One of the advantages of Micro-TESE is that there is no need to repeat sampling for those requiring IVF treatment once again. It is also utilized for fertilization using the ICSI treatment of microinjection.

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Micro-TESE Surgery

What Preparations Must Be Done Before Micro-TESE?

The patient must take precautions and prepare for the procedure before undergoing the micro-TESE, including the following:

  • Remove extra hair from the surgical site, such as the scrotum;
  • Shave the area surrounding the penis and groin the night before the procedure;
  • Consult your doctor in case you are using any kind of anticoagulants, such as aspirin, warfarin, ibuprofen, or nonsteroidal anti-inflammatory medicines;
  • Notify your surgeon whether you have an allergy or intolerance to any anesthetic medications;
  • Report any bleeding to your urological surgeon.


Micro-TESE Aftercare

Patients will be monitored in a recovery area to ensure they are stable and recovering well from the surgery after the procedure. They may experience some discomfort or pain, which can be managed with pain medication prescribed by the surgeon.

In addition, the surgeon will give patients post-operative instructions for smooth Micro-TESE recovery.

  • Take prescribed antibiotics, ibuprofen, Tylenol, and painkillers on a regular basis;
  • Wear a tight pair of jockey shorts for one week to support the scrotum and lower swelling.
  • Put ice packs on the scrotum for 15 minutes every hour for the first 48 hours to reduce swelling;
  • Avoid wearing absorbent or restrictive clothing around the surgical site;
  • Avoid strenuous activities on the first 5 days of the surgery;
  • Avoid tub baths for a week after surgery;
  • Avoid driving for one week after the surgery;
  • Avoid taking any aspirin products for two weeks after the procedure;
  • Avoid getting exercise (running, heavy lifting, long walks, cycling, straining for 1 -2 weeks after Micro-TESE surgery;
  • Avoid Swimming for two weeks;
  • Avoid sexual intercourse for 2 weeks;
  • Report any severe swelling, inflammation, bleeding, or redness at the surgical site to your doctor.


Differences Between Biopsy and Micro-TESE

The biopsy approach involves removing and examining only a small section of the testicle. The sampling method in testicular biopsy is considered one of the defects of this method, as the unstudied areas might have the capacity to produce sperm. On the other hand, in micro-TESE, as soon as sperm is discovered, it can fertilize an egg or be preserved for use later.

Testicular Biopsy
Read more: Testicular Biopsy for Infertility: Procedure & Recovery

What Is the Difference Between TESE and Micro TESE Infertility Treatment?

Men with obstructive azoospermia typically undergo one of two surgical procedures: testicular sperm extraction (TESE) or microscopic testicular sperm extraction (micro-TESE). The surgical technique used in these two approaches is different from one another.

TESE surgery is a common procedure in which some small pieces of testicular tissue are removed through a small incision on the testicle skin and examined. However, the open surgery performed in the micro-TESE procedure provides the option of enlarging the target tissue and inspecting the testicular tissue more suitably. This allows for a more targeted and precise extraction, increasing the chances of finding viable sperm, especially in cases where sperm production is very low.

Furthermore, Micro TESE is considered a more specialized and effective method for men with severe infertility issues. It offers a higher success rate in finding viable sperm and is often recommended for individuals with conditions such as non-obstructive azoospermia.

Micro-TESE Surgery

What Are the causes of Azoospermia?

Azoospermia, or zero sperm count, occurs for several reasons and is aggravated by various factors. Some factors affecting azoospermia include:

  • Infectious diseases such as mumps;
  • Taking some medications, especially drugs for chemotherapy and antibiotics;
  • Radiation therapy in cancer patients;
  • Genetic factors;
  • Hormonal factors;
  • substance use;
  • Occurrence of genital ulcers.


What Are the causes of Azoospermia?

What is the Micro-Tese Success Rate?

The success rate of Micro TESE varies depending on the patient's specific condition and the expertise of the surgeon performing the procedure. However, studies have shown that Micro TESE has a higher chance of successful sperm retrieval compared to traditional TESE. Success rates of 50-60% or even higher have been reported in some studies for infertile men undergoing Micro TESE.

For which type of patients with azoospermia is micro-TESE more successful?

Studies have shown a micro-TESE success rate of 50% for men with Klinefelter Syndrome. Klinefelter Syndrome is a male genetic condition that leads to smaller-than-normal testicle size, low testosterone levels, and the absence of sperm in the semen (azoospermia).

Micro-TESE also has a high success rate of sperm retrieval in patients who had orchiopexy surgery or in men with germ cell aplasia.

When is Microscopic Testicular Sperm Extraction Recommended?

Microscopic testicular sperm extraction (micro-TESE) is typically recommended in cases where a man has been diagnosed with severe male infertility, particularly if there is no sperm present in the ejaculate. This procedure is often used for men with conditions such as non-obstructive azoospermia, where the testicles are not producing enough sperm.

Micro-TESE procedure is also recommended when other methods of sperm retrieval, such as testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA), have been unsuccessful.

Options for Fertility After Vasectomy

While vasectomy is an effective method of contraception, it is not always irreversible. In fact, up to 6% of men who undergo vasectomy may experience a reversal of the procedure due to changes in their personal circumstances, such as remarriage or a desire to have more children.

For men who have undergone vasectomy and wish to conceive a child, there are several options available. One option is vasectomy reversal surgery, which reconnects the vas deferens to allow the passage of sperm. However, this procedure is not always successful, and success rates have decreased over time since the original vasectomy.

Another option is sperm extraction with micro-TESE, which involves the removal of testicular tissue to retrieve viable sperm for use in assisted reproductive technologies. This method has been shown to be successful in men who have undergone vasectomy, even if they have no sperm in their ejaculate.

Vasectomy Surgery
Read more: Vasectomy Procedure: Recovery, Side effects & Effectiveness

Why Infertility Treatment in Iran?

Infertility treatment in Iran is also significantly more affordable compared to many other countries. The cost of procedures such as in vitro fertilization (IVF) and other fertility treatments in Iran can be much lower than in Western countries, making it an attractive option for individuals and couples seeking infertility treatment.

Additionally, Iran has highly skilled and experienced doctors in the field of infertility treatment, with many clinics and hospitals offering state-of-the-art facilities and advanced technology for assisted reproductive techniques. This combination of affordability and quality medical care has made Iran a popular destination for medical tourism for individuals and couples seeking infertility treatment.

Fertility Treatment in Iran

FAQs About Micro-TESE Surgery

What are the Micro Side Effects?

In general, the chance of damaging the testicle itself during the surgery is very low because the scrotum heals quickly after surgery; however, complications like bleeding, infection, pain and discomfort at the surgical site, swelling or bruising in the scrotum, and numbness or tingling in the scrotum may occur for the patient and should be reported to the doctor.

Is it OK to undergo a second micro-TESE if no sperm could be harvested in the first procedure?

In case of no sperm found in the first micro-TESE, the chance of harvesting sperm in a second procedure remains similarly low, around 15 to 20%.

Will the microscopic testicular sperm extraction procedure need to be repeated?

The need for repeated micro TESE procedures can vary from person to person depending on factors such as the underlying cause of male infertility, the quality of the sperm retrieved, and the specific requirements of the fertility treatment.

What is the success rate of micro-TESE surgery?

About 60% of doctors find Micro-TESE ideal, making it a good method for treating male infertility.

What type of anesthesia is used for the micro-TESE procedure?

Micro TESE is typically performed under general anesthesia, which means the patient is completely unconscious during the procedure. This allows the surgeon to carefully and precisely locate and extract sperm from the testicular tissue without causing discomfort or pain to the patient.


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