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Micro-TESE (Microsurgical Testicular Sperm Extraction) is a surgical technique that enables the extraction of sperm directly from the testicle of patients with Azoospermia (absence of sperm in the ejaculate).

This procedure is performed under local or regional anesthesia with a small incision in the scrotum and opening of the testicles. The entire process is conducted with the assistance of a microscope.


Micro-TESE for Male Infertility

In the current state of the art, with the advancement of surgical techniques, sperm can be easily extracted from the testicle in men with Azoospermia.

Micro-TESE is a microsurgical technique in which a small portion of testicular tissue is taken from the active sperm-producing zone with the assistance of a microscope, enhancing precision in the extraction.

The seminiferous tubules (structures where sperm are produced and transported) contain sperm and can often be identified after opening the testicle.

This approach has several advantages over other sperm retrieval techniques, as it maximizes sperm collection while minimizing vascular damage and loss of testicular tissue.

What a patient can expect from a center performing Micro-TESE:

The likelihood of finding sperm with Micro-TESE is over 60%, which is twice as high as traditional TESE (Testicular Sperm Extraction) or other techniques like TESA (Testicular Sperm Aspiration) or MESA (Microsurgical Epididymal Sperm Aspiration).


Which patient needs Micro-TESE?


The absence of sperm in the ejaculate can be caused by various factors:

  1. A patient lacks sperm in seminal fluid due to a production defect (secretory Azoospermia) or a blockage in the spermatic pathway (obstructive Azoospermia).

  2. Congenital absence of ejaculatory ducts.

  3. Damage from medications or radiation used in the treatment of certain tumors.

  4. Hormonal factors.

  5. Infections.

This technique may be recommended for patients who have undergone other unsuccessful procedures.

The patient's journey for Micro-TESE:

The patient undergoes a consultation with a Urologist/Andrologist. The specialist examines and schedules appropriate tests, such as blood tests, hormonal profiling, genetic tests, and infectious markers. After reading, understanding, and signing an informed consent, the surgical procedure will take place.


Duration of Micro-TESE Procedure

The procedure is performed on an outpatient basis, allowing the patient to return home on the same day of the surgical intervention. Micro-TESE can be conducted either before (with sperm freezing) or concurrently with fertilization techniques (ICSI or IVF).

When Micro-TESE is performed simultaneously with ICSI, the success rates are higher.

Micro-TESE Procedure

Pre-operative management:

  • The patient should refrain from eating and drinking at least 6 hours before the procedure.

  • Clean and shave the genital area.

  • Wear comfortable clothing for the post-operative period (tight jeans may cause discomfort).

  • Discharge from the clinic usually occurs 1-2 hours after the procedure.

Post-operative precautions:

  • The patient can start drinking fluids immediately after the procedure (if performed under local anesthesia) or within 3 hours after the completion of Micro-TESE (if performed under spinal anesthesia).

  • Pain relievers are administered if there is immediate postoperative pain.

  • Avoid sexual activity for one week.

  • The operating surgeon conducts a follow-up check within 24/48 hours to prevent potential complications.

  • Micro-TESE employs absorbable stitches, so there is no need for removal, with absorption typically occurring within 7-10 days.


Risks Associated with Micro-TESE

Finding spermatozoa is not guaranteed for all patients. In some cases, there may be a complete absence of seminiferous tubules with only Sertoli cells present (Sertoli Cell Only Syndrome). The likelihood of finding spermatozoa is higher in patients with ductal obstruction (obstructive azoospermia) compared to cases involving genetic or hormonal conditions (secretory azoospermia).

Pain during Micro-TESE

Micro-TESE is a painless procedure performed under local or regional anesthesia. Pain relief measures ensure the absence of postoperative discomfort.

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