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

Microscopic testicular sperm extraction (microTESE) is a cutting-edge procedure that has revolutionized the field of male infertility. This advanced technique offers hope to couples struggling with male factor infertility, such as non-obstructive azoospermia (when a man is not able to make enough healthy sperm naturally), providing them with the opportunity to conceive a biological child through assisted reproductive technologies like IVF. 

The micro-tese procedure involves the use of high-powered surgical microscopes to identify and extract small clusters of sperm directly from the testicles, unlike traditional sperm retrieval methods, such as testicular sperm extraction (TESE), or percutaneous epididymal sperm aspiration (PESA), micro-TESE targets specific areas of the testicular tissue where sperm are more likely to be found.

In the case of no sperm found after the TESE procedure, the options for conceiving a biological child become limited. However, there are still potential options to explore, such as using donor sperm for assisted reproductive technologies like IVF or considering adoption.

Read on to learn more about microscopic testicular sperm extraction, including its procedure, benefits, side effects, and microtese success rate.

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. 

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 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.

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.

Micro-TESE Aftercare

• 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 way of sampling 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 to be used later.

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 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 allows for enlarging the target tissue, inspecting the testicular tissue more suitably, and better identifying the presence or lack of sperm.

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.

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.