Male infertility is a significant aspect in many couples, especially those who are struggling to conceive. One of the most challenging diagnoses found in male infertility is non-obstructive azoospermia (NOA). It is a condition where no sperm or a very small amount of sperm is produced in the testes. If a man is with NOA, conventional sperm retrieval methods often fail, which leaves them with few options to attain biological fatherhood. Here comes the role of Microsurgical Testicular Sperm Extraction (microTESE), a highly specialized surgical procedure that is designed to retrieve sperm directly from the testicular tissue with precision and minimal damage.
In this comprehensive guide, we will explore what microTESE is, who it is for, how it is performed, its benefits and risks, and its role in assisted reproductive technologies like IVF.
What Is MicroTESE?
MicroTESE majorly stands for Microsurgical Testicular Sperm Extraction, a surgical technique that is used to extract sperm directly from the seminiferous tubules inside the testes. It is totally different from other sperm retrieval methods as it makes use of an operating microscope to selectively remove and identify only the areas of testicular tissues that are most likely to contain sperm.
This procedure is recommended especially for men having issues like non-obstructive azoospermia (NOA). It is a condition where the production of sperm is severely absent or impaired to ejaculate, not because of any blockages, but due to testicular dysfunction. MicroTESE can also be considered when other sperm retrieval methods have failed or when sperm count is extremely low.
Who Needs MicroTESE?
MicroTESE is typically recommended for men who:
- When a man is not able to ejaculate any sperm due to impaired sperm production rather than blockage.
- Have already tried to use other sperm retrieval methods, such as needle aspiration or conventional TESE, but have not attained any success.
- Have testicular damage or certain genetic conditions that affect the production of sperm.
- Those who are seeking to have their biological child with the help of ART (assisted reproductive techniques), such as IVF combined with intracytoplasmic sperm injection (ICSI).
How Does MicroTESE Work? The Procedure Explained
MicroTESE is a delicate microsurgical procedure performed under general anesthesia to ensure patient comfort and immobility.
Step-by-Step Procedure:
- Anesthesia and Incision: Initially, a patient is placed under general anesthesia, where the surgeon accesses the testes with the help of a small midline incision.
- Microscopic Examination: Here, a high-powered operating microscope is used to carefully examine the seminiferous tubules after opening the testicular tissues at high magnification. It helps in identifying the enlarged or swollen tubules, which have a high probability of containing sperm.
- Selective Tissue Extraction: In this, a small sample of promising tubules is removed while minimizing unnecessary tissues and reducing any risk of damage to nerves and blood vessels.
- Repeat on Both Testes: The procedure is carried out on both testes so that it could help in enhancing the chances of sperm retrieval.
- Closing the Incision: After extracting tissues, the incision is closed with fine sutures.
- Laboratory Analysis: after extracting the tissue samples, they are handed over to an andrology laboratory immediately so that they can be examined with the help of a microscope, so that viable sperm can be located. If sperms are found, they are separated, prepared, and even frozen so that it can be used for future use in IVF/ICSI.
Advantages of MicroTESE Over Other Sperm Retrieval Methods
- Higher Success Rates: The success rate of MicroTESE is higher as it has shown a significantly higher sperm retrieval rate, which is 40-70%, as compared to needle aspiration or conventional TESE, especially in men with NOA.
- Precision and Minimal Tissue Damage: Microscope usage allows surgeons to target only those specified areas that are more likely to contain sperm. It helps in having those that preserve healthy testicular tissue and reduce complications.
- Reduced Risk of Testicular Damage: Because microTESE is more selective, it lowers the risk of damaging blood vessels and nerves, minimizing postoperative pain and preserving testicular function.
- Better Outcomes for IVF: Viable sperm are retrieved with the help of microTESE ,which enables couples to pursue IVF with intracytoplasmic sperm injection (ICSI), increasing the chances of fertilization and pregnancy.
Risks and Considerations
While microTESE is generally safe, it is a surgical procedure and carries some risks:
- Minor bleeding or bruising inside the scrotum can occur.
- Though rare, infections can develop at the surgical site or within the testicle.
- As with any surgery requiring general anesthesia, there are inherent risks that your anesthesiologist will discuss.
- Despite careful technique, there is no guarantee sperm will be found, especially in severe cases of testicular failure.
- Some causes of azoospermia may be genetic, and using sperm retrieved via microTESE could pass on infertility or other genetic conditions to offspring. Genetic counseling is recommended.
- Though minimized, there is a small risk of damage to testicular tissue or blood supply, which could affect hormone production or testicular size.
Recovery After MicroTESE
Recovery from microTESE is generally straightforward but requires some care:
- Pain Management: Mild or moderate pain is common, and if you are facing such pain or swelling after surgery. This could be managed with the help of ice packs and prescribed painkillers.
- Activity Restrictions: it is also recommended that they should avoid heavy lifting, sexual activity, or strenuous exercise for 1-2 weeks so that it could help in healing.
- Follow-Up: You should also go for your follow-up visits so that the healing process is assessed and sperm retrieval results can be discussed correctly.
- Emotional Support: Though the process could be emotionally taxing, support groups and counseling could help you overcome the same.
MicroTESE and Assisted Reproductive Technologies (ART)
The sperm retrieved via microTESE are typically used in conjunction with Intracytoplasmic Sperm Injection (ICSI), an IVF technique where a single sperm is injected directly into an egg. This method bypasses natural fertilization barriers and is essential when sperm numbers are very low or sperm motility is poor.
Because sperm retrieved from testicular tissue may be limited, they are often frozen (cryopreserved) immediately after extraction to allow multiple IVF cycles without repeated surgeries.
Success Rates and Prognosis
The success of microTESE depends on several factors:
- Underlying cause of azoospermia: Men with certain genetic or hormonal causes may have lower sperm retrieval rates.
- Surgeon experience: MicroTESE requires microsurgical expertise; outcomes improve with skilled surgeons.
- Testicular histology: Some men have focal areas of sperm production despite widespread testicular failure, which microTESE can identify.
Overall sperm retrieval rates range from 40% to 70%, with pregnancy rates following IVF/ICSI varying accordingly.
Who Should Consider MicroTESE?
Men diagnosed with non-obstructive azoospermia who want to father biological children and have no sperm in their ejaculate are prime candidates. It is important to have:
- Comprehensive evaluation by a fertility specialist and urologist
- Genetic counseling if indicated
- Discussion of alternatives, including donor sperm or adoption, if microTESE is unsuccessful
Conclusion
MicroTESE represents a revolutionary advancement in the treatment of severe male infertility caused by impaired sperm production. By combining microsurgical precision with advanced laboratory techniques, microTESE offers hope to men previously considered untreatable. While not guaranteed, the procedure significantly increases the chances of retrieving viable sperm for use in assisted reproductive technologies, enabling many couples to achieve their dream of parenthood.
If you or your partner face male infertility challenges, consulting with a fertility specialist experienced at Aveya IVF Centre can help you with MicroTESE if this procedure is the right option for you.
