Men undergoing evaluation are found to have Azoospermia, commonly described as a lack of sperm ejaculation. The term Azoospermia means that there is no presence of sperm in a person to perform the ICSI. In such a case, a surgical extraction can be performed to check if any variable of sperm is present in the testis.
Rather than performing Sperm ejaculation, there are other methods by which sperm can be retrieved directly from the testicles. The procedure of retrieving sperm directly is commonly known as Testicular Sperm Aspiration (TESA), Testicular Sperm Extraction (TESE), or Percutaneous Epididymal Sperm Aspiration (PESA), and Micro-TESE.
The main aim of this article is to understand the predictive value of preoperative hormonal levels including pathology, and also to understand the Microsurgical Testicular sperm extraction in a person who faces Non-Obstructive Azoospermia (NOA). This is further performed so that individuals can choose the best way to conceive when they plan to.
What is Micro TESE?Microsurgical Testicular Sperm Extraction commonly known as Micro-TESE is a surgical procedure that is performed to retrieve sperm from the male testicles seminiferous tubules. The Micro-TESE is an effective procedure that a man should perform if he is affected with a problem that indicates zero presence of sperm in the semen ejaculated at the time of orgasm, commonly called Non-Obstructive-Azoospermia. This is furthermore, a common cause of infertility among couples. The main difference between TESE and Micro TESE is that the Micro TESE is performed with the help of a microscope. The urologist may further differentiate between the production of the sperm in the center tubules more efficiently with the help of Microscopic observation. In this way, Micro TESE is more efficient in finding the sperm and helps to minimize the damage amount to the remaining testis.
In Vitro Fertilization
In vitro fertilization is a modern reproductive procedure. We use it to treat infertility and help couples in conceiving. During IVF, developed eggs are extracted from ovaries and fertilized by sperm in a laboratory.
In Vitro Maturation
In-vitro maturation, or IVM, is an assisted reproductive technology (ART). The original procedure of oocyte IVM has been accessible since the 1990s; however, doctors rarely use it due to IVF viewing better returns.
Laser Assisted Hatching
By creating a hole in the zona pellucida membrane (the outermost layer of the embryo’s shell), a technique known as laser-assisted hatching
IVF failure is the most common thing as unfortunately; IVF treatment cannot provide you success. An IVF failure can be the most frustrating thing ever for you and your partner.
Sperm Donation is the process where a male gender provides his sperm to another couple or person. The overall process of collecting and donating semen to a person or couple is sperm donation.
Repeated Implantation Failure
At the time of transferring embryos with the help of In Vitro Fertilization when the embryos fail to get transplanted, it can be then considered as the Implantation Failure.
Preimplantation Genetic Testing
A woman who faces infertility or recurrent pregnancy loss, that woman is chronic to the chromosomal abnormalities in the embryo.
Women’s ovaries produce gametes known as ova or ovum. These immature egg cells become mature ovum during a menstrual cycle.
Oligo Astheno Teratozoospermia
Oligo-Astheno-teratozoospermia (OAT) is a condition that leads to a low sperm count. This condition does not include anyone kind of disorder but can be divided into three disorders.
After you conceive a baby through IVF, you could uncover a circumstance that suggests more embryos than you are known. In such situations, you can either store them for the future or can discard them.
Sperm Freezing & Vitrification
Another name for sperm is spermatozoon which is in a plural form known as spermatozoa. This is a male reproductive cell, produced by the male gender animals.
Embryos Freezing & Vitrification
The embryo is defined as the early stage of development of a multicellular organism that is reproduced sexually. In simple terms, Embryo is an organism that has not totally developed and is in the previous stage of growth and differentiation.
Microsurgical Testicular Sperm Extraction commonly known as Micro-TESE is a surgical procedure that is performed to retrieve sperm from the male testicles seminiferous tubules.
Endometrial Receptivity Analysis
ERA or Endometrial Receptivity Analysis is a genetic test to evaluate endometrial lining. Only a developed endometrial lining accepts embryos and increases the implantation chances.
When you should consider the Micro TESE?
Doctors or Urologists can suggest a person undergo a Micro TESE on the following conditions:
- When a person’s blood has zero adequate levels of testosterone after performing a hormone test and also when a person has performed other tests but no normal amount of sperm can be traced in the testicles.
- The situation when a person remains Azoospermic even after receiving treatment and in addition when his testosterone has been in a normal condition for at least a maximum of 4 mounts.
What is the procedure of performing Micro-TESE?
Micro TESE is a surgical procedure performed by an experienced doctor. In this procedure, the doctor performs a very small cut or incision o0f about 2-3 cm just in the midline of the Scrotum. The doctor also performs general anesthesia before performing the surgery. With the help of the incision, your doctor will cut open your testicles to further look for the presence of sperm with the help of a high-power operating microscope with 30-40x magnification technology. Moreover, this is further performed in the seminiferous tubules that are swollen and have chances of containing sperm.
After performing this, your doctor will try to take out the sperm tissue sample from the testis tubules to stop the bleeding. Furthermore, your doctor will close the cut while performing very fine stitches in the testis.
In addition, after collecting the tissue cells the cut is closed and with the help of a sature the cuts are also further dissolved on their own and thus it remains no scars of surgery. The tissue samples are then further transferred to the andrology technologist, who performs a thorough check-up to find out the status of the sperm with the help of a microscope.
12+ Years of Experience as
Sexologist and Infertility Specialist
12+ Years of Experience as
Sexologist and Infertility Specialist
What is the possible risk of Micro TESE?
While performing a Micro TESE, there are few risk factors that you should know. The risk factors are further listed below for your better understanding:
- Infection on the skin or in the testicles
- Difficulty to find sperm
- Transmitting the potential genetic cause to any offspring and further causing infertility.
- Damage of the testicles, which is a rare condition.
- General anesthesia risk factors.
If a person does not find the Micro TESE as a viable option then there are other options that include sperm donation and adaption.
Explain the recovery from Micro TESE?
One of the fastest healing parts of the entire body is considered the scrotum and thus results in a fast recovery. Several men recover in a fast manner after performing the scrotum surgery and have bearable pain in the testis after the surgery. No matter how minimum the pain is your doctor will still provide you some medications that will also further help you to deal with the pain and perform a quick recovery. Micro TESE with multi-layer closure technique also further helps to prevent a person from causing infections or bleeding after the surgery.
Post Surgical CareThough there are minimum chances of having any serious pain after the surgery, it is still recommended to patients use an ice pack for the first 24 hours after going through the surgery. It is also recommended to use 800 mg of Ibuprofen for the first three days with a gap of 8 hours. The 650 mg Tylenol is further recommended to keep away the pain. If you still feel any discomfort you can take the further prescribed medicines or can directly contact the doctor.
What is the success rate of Micro TESA?The Micro TESE is one of the most successful and efficient methods if performed by an experienced person. This provides infertile NOA men an opportunity to become a father and to have a family again. Moreover, a report stated that the unselected person with the NOA disorder should first perform counseling at the outset and only 17.9% among them will eventually become the biological father which is also quite high.
Why Micro TESA is considered the most successful method of Sperm Retrieval?
Micro TESA is one of the successful methods of surgery as it requires highly experienced surgeons and technologists to perform sperm surgery. At the time of the surgery apart from surgeons there will andrology lab technologist to witness the process of your seminiferous tubules for sperm.
If there is any presence of sperm it will be further stored to perform future reproductive treatments, including In Vitro Fertilization with ICSI. According to research it is showed that frozen sperm are more active and can perform well compared to fresh sperm during IVF.
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Dr. Ramit Raosaheb Kamate
MBBS ,DNB, DGO, FRM (UK)
Dr. Ramit Kamate is a Reproductive Medicine Consultant and Sexologist with experience of 12+ years. He specialises in Sexual Medicine for male and female, Fertility Treatment, Pre and Post Delivery Care, Normal Vaginal Delivery (NVD), Tubectomy/Tubal Ligation, Natural Cycle IVF, MTP.
Dr. Ramit Kamate finished MBBS from B J Medical College, Pune. He pursued Masters’s In Reproductive Medicine from Hamilton University, UK & IBCME Dubai. Completed Fellowship in Cosmetic Gynaecology and Sexual Medicine from USA.
MBBS DGO DNB Gold Medalist
Fellow In Sexual Medicine (USA)
Fellow In Reproductive Medicine
Fellow In Cosmetic Gynecology (USA)
Fellow In Ultrasound And Laparoscopy
Fellow In Stem Cell Medicine
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