Advances in reproductive medicine over the last 10 years have allowed men who were previously considered absolutely sterile to father biological children. It turns out that men who have no sperm in the ejaculate because of problems with sperm production, a condition called Non-Obstructive Azoospermia (NOA), actually may have small pockets of sperm production within the testicle. In fact, greater than 60% of men with NOA actually do produce small amounts of sperm inside the testicle that can be used with ICSI (Intracytoplasmic Sperm Injection) to create a baby.
TESE (Testicular Sperm Extraction) or Micro-TESE (Microsurgical Testicular Sperm Extraction) offers the opportunity to obtain spermatozoa directly from the testis in cases diagnosed with azoospermia. TESE was the technique that was used in every case until recently. Micro-TESE is a revolutionary method that is used in non obstructive azoospermic men and with the use of a high magnification operating microscope the doctor examines the tubules at the time of testicular biopsy. This way the urologist selectively removes the “better” or more normal appearing tubules where sperm is detected in the testicles of men who have poor sperm production. The chance of finding sperm with Micro-TESE is better than 60%. This is twice the chances of finding sperm by non-microsurgical or needle biopsies. This advanced technique allows us to direct the biopsy to the best areas and increase the chance of finding sperm while removing smaller amounts of tissue then a random biopsy, causing less damage. Random biopsies are simply inaccurate; it is impossible for a doctor to find possible pockets of sperm by observing the exterior of a testicle, other than by luck. Once the specimens are removed, the tubules are opened in a Petri dish containing sperm wash media and the search for sperm begins by examining the specimens under the microscope. It can take up to five hours to search for sperm in the specimens. This is a very involved and tedious process, but very thorough and important. Once they are found, the sperm are then either incubated and injected into awaiting eggs or frozen for future use.
Micro-TESE can be performed as a diagnostic procedure and if usable sperm are found, then they can be frozen and the couple is recommended to proceed with ICSI. It can also be performed and timed with an egg retrieval/IVF cycle so that the sperm are injected into the eggs without freezing. Freezing the sperm from men with sperm production problems can be difficult since these sperm are usually few in number and don’t thaw well. Therefore the best chance of pregnancy is to use fresh sperm obtained just prior to IVF. Micro-TESE is a great advance in male reproductive surgery.