Testicular sperm extraction is the collection of sperm through a biopsy of the testicles. For men with non-obstructive azoospermia, this reproductive procedure is the only option for having a child of their own. The sperm is later injected into female eggs as part of ICSI.
What is testicular sperm extraction?
Sperm is extracted from the man’s testicles as part of this treatment, which is used to artificially fertilize an egg. Testicular sperm extraction is what reproductive physicians refer to as the first step in fertility treatment. In short, the procedure is also called TESE. During this treatment, sperm are extracted from the man’s testicles, which are used for artificial fertilization of an egg. TESE is basically the same as sperm collection during a testicular biopsy. The procedure has been used since 1993 and usually takes place in combination with combined fertility treatment. Most often, TESE is followed by ICSI, which is intracytoplasmic sperm injection. In this method, the male’s sperm cells are injected directly into an egg. The so-called reproductive medicine, which has been established as a separate branch of medicine since the 20th century, is responsible for all treatments relevant to reproduction. The goal of most reproductive medicine treatments is to restore fertility and thus fulfill a previously unfulfilled desire to have children.
Function, effect, and goals
TESE is aimed primarily at infertile men with azoospermia. In this phenomenon, there are no sperm cells in the ejaculate. Thus, the man cannot fertilize his wife’s egg naturally. TESE makes fertilization possible and thus fulfills a couple’s wish to have a child despite azoospermia. In about 15 percent of all childless couples, azoospermia is responsible for the unfulfilled desire to have a child. Accordingly, TESE is frequently performed in reproductive medicine. Doctors distinguish between two different forms of azoospermia: an obstructive and a non-obstructive type. In the obstructive form, an obstruction in the seminal ducts prevents sperm from advancing to the ejaculate. However, since this form of azoospermia is usually due to a vasectomy, reproductive medicine treats affected individuals in this case with refertilization surgery rather than TESE. Non-obstructive azoospermia, on the other hand, is a disorder of sperm production. In this condition, sperm cells are often present directly in the testes, but are unable to penetrate into the ejaculate due to their low density or restricted motility. Accordingly, for men with non-obstructive azoospermia, TESE is the only useful reproductive treatment. Usually, TESE takes place on an outpatient basis and is performed under either partial or general anesthesia. The general psychological condition of the patient and the findings determine the form of anesthesia in each individual case. The biopsy can be performed on one side or on both sides. This is also decided in individual cases by the findings. Through a small incision in the scrotum, the reproductive physician exposes the testicle during TESE. The scrotum and its ducts are then inspected before the surgeon incises the testicular capsule. After taking a tiny tissue sample, the team examines this tissue for sperm. Depending on the findings, the further procedure is decided. If there are enough sperm, part of the tissue sample is frozen. This step is also known as cryopreservation and keeps the sperm alive until they can be injected into an egg during ICSI. The doctor usually finishes by suturing the incisions with a self-dissolving suture.
Risks, side effects and dangers
The tissue sample removed during a TESE is relatively small. Accordingly, the risk of permanent damage to the patient is low. After about two weeks, the surgical area is completely healed. Showering is permitted again just two days after the operation. After about ten days, the patient may bathe or visit the sauna again. However, until the biopsied area is completely healed, tight clothing should not be worn. Heavy physical work and sports are not allowed for about three weeks. The patient should also refrain from sexual activity for about one month.Office work, on the other hand, can be resumed as early as three days after surgery. Since TESE uses self-dissolving sutures for suturing, no stitches need to be removed. The risk of complications with this operation is extremely low. Infections or bleeding occur in only rare cases. Sometimes there is a bruise on the scrotum, but this soon disappears on its own. Slight pain or pulling in the area of the stitches may occur, but usually does not last long. The general risk of the operation is considered to be low. At about the same time as the TESE, eggs are retrieved from the woman. These eggs are fertilized by injection with the retrieved sperm. The restricted density or flow rate of the sperm does not matter for this method. Later, about three of the eggs fertilized in this way are reinserted into the woman. Thus, the woman experiences pregnancy despite or, in this case, thanks to artificial insemination. However, reproductive medicine cannot guarantee that its methods will work. When reproductive medicine treatment comes to nothing, it often has a stressful effect on the patient’s psyche. Some couples even separate after a failed treatment.
