Testicular Sperm Extraction (TESE)
by Antoine Abu Musa
Fertility Consultant
Chief Medical Officer
What is Testicular Sperm Extraction (TESE)?
Testicular Sperm Extraction (TESE) is a surgical procedure performed to retrieve sperm directly from the testicles of men who have difficulties producing sperm in their ejaculate. This procedure is typically used in cases of male infertility, such as azoospermia (the absence of sperm in the ejaculate). TESE is an important step in assisted reproductive techniques like in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) to help couples achieve a pregnancy.
Indications
TESE is recommended for individuals who are unable to produce sperm through ejaculation, a condition known as azoospermia. Azoospermia affects approximately 1% of the general population, and this percentage increases to 15% within the infertile population. Azoospermia can be classified into two main types:
- Non-Obstructive Azoospermia (NOA): TESE is primarily used for NOA, where there is no sperm in the ejaculate but the potential for sperm production within the testis exists. In this type, there is testicular failure leading to reduced sperm production. It can result from genetic factors, chromosomal abnormalities, infections, medication, incomplete testicular descent, trauma, or other underlying causes.
- Obstructive Azoospermia (OA): In OA, sperm is produced in the testicles, but an obstruction prevents it from reaching the ejaculate. Causes can be congenital (e.g., congenital bilateral absence of the vas deferens) or acquired (e.g., vasectomy, infections, trauma).
TESE can also be considered for individuals who have difficulty obtaining a sperm sample through ejaculation or those whose sample’s quantity or quality is insufficient for successful assisted reproduction techniques.
Procedure
TESE is typically performed as an outpatient procedure under local or general anaesthesia. The steps involved in the TESE procedure are as follows:
- Incision: A small incision is made in the scrotum or the upper part of the testicle.
- Testicular Tissue Extraction: A small piece of testicular tissue is extracted.
- Sperm Identification: The extracted tissue is examined under a microscope to identify the presence of sperm.
- Sperm Use: The retrieved sperm can be used in various assisted reproductive techniques, including IVF and ICSI.
Types of TESE
- Conventional TESE: This is the standard TESE procedure where testicular tissue is randomly sampled to retrieve sperm.
- Microdissection TESE (Micro-TESE): In Micro-TESE, an operating microscope is used to identify regions within the testicle that are more likely to contain spermatozoa. While it is more invasive and typically performed under general anaesthesia, micro-TESE offers higher success rates in extracting sperm.
Risks and Complications
TESE is a generally safe procedure, but like any surgery, it carries some risks, including:
- Infection: There is a small risk of infection at the incision site.
- Bleeding: Excessive bleeding is rare but can occur.
- Testicular Damage: In rare cases, damage to the testicle may occur. Tissue scarring, inflammation, and fibrosis could affect future sperm production or testosterone levels.
Recovery and Follow-Up
After the TESE procedure, you may need some time to recover. It’s essential to follow your healthcare provider’s post-operative care instructions. After the TESE procedure, patients are typically advised to:
- Rest: Avoid strenuous activities for a few days to allow for proper healing.
- Pain Management: Over-the-counter pain relievers can help manage discomfort.
- Follow-Up: A follow-up appointment with the urologist is usually scheduled to monitor progress.
How can we help?
NOW-fertility offers a variety of assisted conception techniques, in order to help you achieve a pregnancy. If you are recommended for TESE or are considering this procedure, NOW-fertility will provide you with personalised guidance based on your specific situation and help you make informed decisions regarding your fertility journey.
Ready to start your journey?
Our commitment is to make fertility care accessible, successful and stress free for patients.
If you are ready to start your journey, book a consultation with one of our experienced fertility consultants.
