Micro-TESE (Microdissection Testicular Sperm Extraction)

Microdissection Testicular Sperm Extraction (Micro-TESE) is an advanced surgical option for men who have no sperm in their ejaculate due to impaired sperm production, a condition known as non-obstructive azoospermia.

During the procedure, a urologist or andrologist with microsurgical expertise examines the testicular tissue under an operating microscope. The surgeon identifies and collects selected areas of tissue that may contain sperm-producing tubules while aiming to preserve as much healthy tissue as possible.

The retrieved tissue is examined by an embryology laboratory to determine whether sperm are present. If viable sperm are found, they may be used for intracytoplasmic sperm injection (ICSI) as part of an assisted reproduction treatment plan, sometimes after cryopreservation.

Sperm retrieval is not guaranteed. The likelihood of success depends on factors such as the underlying cause of azoospermia, previous testicular procedures, hormonal findings, and the patient's overall reproductive health.

Micro-TESE may be considered for men with:

• Non-obstructive azoospermia, where sperm production is significantly reduced or impaired.

• Certain genetic or hormonal conditions associated with impaired sperm production, following specialist assessment.

• A previous unsuccessful sperm retrieval procedure, where repeat surgery is considered appropriate.

• A need for surgically retrieved sperm for use in assisted reproductive techniques such as ICSI.

Micro-TESE is generally not the first choice for obstructive azoospermia, where sperm production may be normal but sperm transport is blocked. Other sperm retrieval methods may be more appropriate in these cases.

Causes of Non-Obstructive Azoospermia

Possible causes include:

• Genetic conditions that affect sperm production.

• Hormonal disorders affecting testicular function.

• Previous chemotherapy or radiotherapy.

• Testicular injury, infection, or certain surgeries.

• Undescended testicles, particularly when treatment was delayed.

• Testicular failure or other conditions affecting sperm-producing tissue.

In some men, the exact cause may remain unknown even after a comprehensive evaluation.

How Is Micro-TESE Performed?

The procedure generally involves the following steps:

1. Preoperative Assessment: The specialist reviews the medical and reproductive history, previous investigations, hormone levels, and relevant genetic tests.

2. Anesthesia: The procedure is usually performed under general anesthesia, depending on the patient's circumstances and the clinical team's plan.

3. Microsurgical Examination: The surgeon makes an incision in the testicle and examines the tissue using an operating microscope to identify tubules that may contain sperm.

4. Tissue Retrieval: Selected tissue samples are collected while aiming to minimize damage to surrounding testicular tissue.

5. Laboratory Examination: An embryology laboratory examines the samples for the presence of sperm.

6. Sperm Use or Preservation: If suitable sperm are retrieved, they may be used for ICSI or frozen for future treatment, depending on sperm quality and the fertility team's recommendations.

Benefits of Micro-TESE

Potential benefits include:

• The opportunity to retrieve sperm in selected cases of non-obstructive azoospermia.

• Microsurgical identification of testicular tubules that may contain sperm.

• An approach designed to limit unnecessary tissue removal compared with less targeted extraction techniques.

• The possibility of using retrieved sperm for ICSI.

• The option to cryopreserve suitable sperm for future fertility treatment.

The procedure cannot guarantee sperm retrieval, fertilization, pregnancy, or a live birth.

Diagnostic Tests Before Micro-TESE

Before recommending Micro-TESE, the specialist may request:

• Semen analysis, sometimes repeated to confirm azoospermia.

• Hormonal tests, including FSH, LH, and testosterone.

• Genetic testing, such as karyotyping or Y-chromosome microdeletion analysis, when indicated.

• A physical examination and review of testicular size and function.

• Additional investigations based on the suspected cause of azoospermia.

These assessments help guide treatment decisions and provide a more individualized discussion of the potential benefits and limitations of surgery.

Recovery After Micro-TESE

Recovery varies depending on the extent of the procedure and the patient's general health. Most patients need a short period of rest and should follow the surgeon's instructions regarding wound care, pain relief, physical activity, and sexual activity.

Temporary pain, swelling, bruising, or discomfort may occur. Patients should seek prompt medical advice if they experience severe or increasing pain, significant swelling, fever, wound discharge, or bleeding.

Testosterone levels may decrease after surgery in some patients, particularly those with pre-existing testicular dysfunction. Follow-up may include hormonal assessment when clinically indicated.

Risks and Possible Complications

As with any surgical procedure, Micro-TESE carries potential risks, including:

• Pain, bruising, and swelling.

• Bleeding or infection.

• Injury to testicular tissue.

• A temporary or, less commonly, persistent reduction in testosterone production.

• Failure to retrieve sperm.

The treating specialist should explain the expected benefits, risks, and alternatives based on the patient's individual findings.

Is Micro-TESE Suitable for Every Man With Azoospermia?

No. Micro-TESE is primarily considered for selected men with non-obstructive azoospermia. The appropriate approach depends on the underlying cause, hormonal and genetic findings, previous treatments, and reproductive goals.

A specialist consultation is important to determine whether Micro-TESE, another sperm retrieval method, or an alternative fertility pathway is most appropriate.