Testicular sperm extraction (TESE; i.e., “extraction of sperm from the testis”; synonym: testicular biopsy) is performed by microsurgical means. The procedure is always combined with intracytoplamatic sperm injection (ICSI) and in vitro fertilization (IVF).
Indications (areas of application)
- Testicular atrophy (“shrunken testis”).
- Sertoli-cell-only syndrome – Special form of testicular (testicular-related) infertility; characterized by severely reduced or absent spermatogenesis (spermatogenesis) despite the presence of both Sertoli and Leydig cells.Note: The major function of Leydig cells is testosterone synthesis.
- Scarring from previous surgery making microsurgical epididymal sperm aspiration (MESA) impossible.
- Testicular azoospermia (testicular-related sperm production disorder; azoospermia = absence of mature as well as immature sperm in the ejaculate).
TESE has even allowed some spermatozoa to be extracted from patients with Klinefelter syndrome.
Before surgery
Testicular sperm extraction and intracytoplamatic sperm injection (ICSI) must be preceded by an examination of the man by physicians with the additional designation of “andrology.” This includes a personal, family and couple history including a sexual history, a physical examination and an ejaculate analysis (including spermiogram/sperm cell examination). If indicated, this is supplemented by scrotal sonography (ultrasound of the testicles and epididymis) and, if necessary, hormone diagnostics and cyto- or molecular genetic diagnostics. If sexually transmitted diseases (STDs) and other urogenital infections are present that could endanger the woman or child, these must be treated [Guidelines: Diagnosis and therapy before assisted reproductive medicine treatment (ART)].Anticoagulants (anticoagulants) should not be taken for up to 7 days before surgery.
The procedure
After local anesthesia (local anesthetic) of the scrotum (testicular skin) and funiculus spermaticus (spermatic cord), the testis is exposed through a small incision on the scrotum (1-2 cm). This is followed by a biopsy (removal of tissue) from several sites on the testicle (usually 3 sites). The larger portions of tissue go directly to the IVF laboratory to be examined for spermatozoa (sperm cells). Micro-TESE: Testicular spermatozoa are collected with the help of a surgical microscope by visiting the areas with dilated testicular tubules where there is residual spermatogenesis in a focal shape. In case of positive results, the spermatozoa are promptly cryopreserved (frozen) in individual portions (straws). A small part of the obtained testicular tissue is given to the pathology department for further histological (fine tissue) diagnostics. Wound closure of the skin is done with self-dissolving sutures. Fresh TESE: This procedure does not involve cryopreservation, i.e. surgical sperm preservation is immediately followed by intracytoplasmic sperm injection and then in vitro fertilization. The procedure reduces the cost of cryopreservation and at the same time decreases the risk of losing more spermatozoa due to cryopreservation, however, the woman may be spared unnecessary hormonal treatment if no fertilizable spermatozoa are found during TESE. The procedure takes place under general anesthesia. The duration of the operation is approximately 30 minutes.
After the operation
After the procedure, the patient remains in the recovery area for about 1-2 hours. He should then take it easy for five days. Showering should be done on the next day at the earliest. Bathing and saunas should be avoided for approximately 2 weeks.
Possible complications
- Hematoma (bruise)
- Scrotal edema (swelling of the scrotum).
- Epididymitis (inflammation of the epididymis)
Please note
The physical and mental health of men and women, as well as a healthy lifestyle are important prerequisites for successful fertility treatment. Before starting therapeutic measures, you should in any case – as far as possible – reduce your individual risk factors! Therefore, before starting any reproductive medical measure (e.g. IUI, IVF, etc.), have a health check and a nutritional analysis performed to optimize your personal fertility (fertility).
