TESE and micro-TESE (performed with a microscope) are more advanced techniques used to extract sperm in man who does not have sperm in his semen (azoospermia).
TESE and micro-TESE are methods that sperms are directly retrieved from the testicular germinal epithelium. Tissue samples that are taken from the outer testicular layer by small incisions are referred to the embryology laboratory.
The fresh sperm that is retrieved are immediately used for oocyte fertilization with ICSI method at the same day of oocyte retrieval in an IVF cycle and the spare sperm is cryopreserved to avoid the need to repeat the procedure. If sperm will not be used for ICSI it can be frozen for use at a later time.
The procedures are performed on the outpatient basis in a short general anesthesia or spinal anesthesia and requires an incision on the scrotum to gain access to the testicles.
TESE or micro-TESE is very successful in cases of obstructive azoospermia (Obstruction in the ejaculatory system-epididymis, vas deferens, or ejaculatory channels, conducting the sperm thus, sperm creation in the testis is normal).
TESE can also be very useful in patients with non-obstructive azoospermia (NOA). There are several genetic, infection-related and hormonal conditions that lead to very low levels of sperm production that can be uncovered through surgery.
For TESE, a standard open surgical biopsy technique is used to remove the testicular parenchyma without the aid of optical magnification. A 2-cm transverse incision is made through the anterior scrotal skin and tunica vaginalis. A 1-cm incision is made in the albuginea, and gentle pressure is applied to the testis to aid the extrusion of the testicular parenchyma. A fragment of approximately 5x5 mm is excised with sharp scissors and placed in sperm culture media. Single or multiple specimens can be extracted from the same incision.
Depending on the underlying medical condition, albuginea incisions can be made for the sampling of different areas. Several testicular samples are taken and immediately.sent to the laboratory for processing and immediate microscopic examination. Any sperm found can be used immediately to fertilize an egg (ICSI) or they can be frozen for later use.
The tunica albuginea is closed with sutures. The testicle is then repaired and placed back into the scrotum. The testicle is generally able to function normally after the procedure and continue to produce testosterone.
The micro-TESE method is a technique that requires microsurgery. Micro-TESE is a TESE procedure that is performed with the use of an operating microscope that allows the surgeon to observe regions of seminiferous tubules of the testes those have more chance of containing spermatozoa. Similarly to TESE, an incision is made in the scrotum and surface of the testicle to expose seminiferous tubules. However, this exposure is much more wide in micro-TESE. This allows exploration of the incision under the microscope to identify areas of tubules more likely to contain more sperm.
Taking advantage of the 30-fold magnification of the microscope, the thin tubules called tubulus, where sperm production is carried out, are enlarged under the operating microscope and large opaque whitish tubules are distinguished.
These tubules contain more spermatogenically active germ cells. These tubules are examined by the embryologist, the sperm inside the tubule is retrieved and the sperm is searched under a microscope with a larger magnification (200-400) times.
If no sperm can be identified, biopsies are taken at random from a wide range of locations. The incision is closed with sutures. Samples are re-examined post-surgery to locate and then purify sperm.
Micro TESE is an operation performed under operating room conditions and general anesthesia and takes approximately 1-2 hours.
The duration of the surgery depends on whether the sperm can be found or not. This period can sometimes exceed two hours. However, if healthy sperm is found, the process can be terminated in a very short time.
There is no definite answer to the question. First of all, the clinical findings of the patient and the results of the TESE procedures they have undergone should be evaluated. After this evaluation, it is decided whether there is a need to repeat the TESE process. Micro-TESE surgery can be performed more than once if deemed necessary.
If no sperm is found after micro-TESE surgery, the tissues taken must be sent for pathological examination. The pathological diagnosis to be obtained as a result of this examination is a guide in terms of the possibility of finding sperm in the future TESE procedures that the patient will have. If a positive pathological diagnosis is obtained and sperm precursor cells are found, TESE can be performed again.
TESE and micro-TESE surgery mostly does not adversely affect the quality of life of patients. Complication rates are also low, as the patient is relatively more comfortable compared to other surgeries. However, negative side effects such as infection, swelling, redness, testicular inflammation, bleeding, hematoma (blood clot accumulation),decrease in testicular volume may occur at the wound site. The likelihood of these side effects is much lower in good centers and experienced hands.
Those who have babies with TESE and Micro-TESE can have the second baby when they request, if the sperm obtained during the procedure is frozen.
The most important decisive factor here is the pathology result of the sample taken in the first surgery and how long the treatment to be started afterwards will be continued. Generally, it is recommended to wait at least 6 months for the second surgery after the first surgery.
There are no specific selection criteria for micro TESE surgery. If sperm cannot be found, sperm search should be performed by intervening in both testicles. When both testicles are present, the physician decides which one to start first, according to the patient's current medical characteristics.
The sperm is first searched on one side of the testis, if necessary, micro-TESE is applied to the testis on the other side.
Micro-TESE surgery is a method for sperm retrieval azoospermia patients so it is also an operation performed to search for sperm for patients with Klinefelter Syndrome.
IVF TREATMENT ISTANBULProf. Dr. Nilgün Turhan
IVF TREATMENT ISTANBUL
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