Micro-TESE (microdissection testicular sperm extraction) surgery is a specialized surgical procedure used in reproductive medicine to retrieve sperm from the testes of men with non-obstructive azoospermia. Azoospermia refers to the absence of sperm in the ejaculate, and non-obstructive azoospermia is a condition where the testes fail to produce an adequate number of sperm. I will explore the concept of micro-TESE surgery, its procedure, benefits, and considerations.
Micro-TESE surgery is considered the most advanced and effective technique for sperm retrieval in men with non-obstructive azoospermia. Unlike traditional methods such as conventional testicular sperm extraction (TESE), which involves random sampling of testicular tissue, micro-TESE utilizes a high-powered operating microscope to selectively identify and extract small patches of potentially viable sperm-producing tissue.
The procedure is typically performed under general anesthesia. A small incision is made in the scrotum to expose the testes. Using surgical precision and an operating microscope, the surgeon meticulously examines the testicular tissue for signs of sperm production. The goal is to identify areas of the testes where sperm production is most likely to be occurring. These areas, known as “hotspots,” are visually distinguishable by the presence of tubules that are larger and firmer compared to the surrounding tissue.
Once the hotspots are identified, the surgeon carefully removes small samples of the testicular tissue. These samples are then immediately examined under the microscope by an embryologist to search for sperm. If sperm are found, they can be used for various assisted reproductive techniques, such as intracytoplasmic sperm injection (ICSI) during in vitro fertilization (IVF).
Advantages of Micro-TESE
One of the primary advantages of micro-TESE is its high success rate in retrieving viable sperm. Unlike other techniques such as conventional Testicular Sperm Extraction (TESE) or Percutaneous Epididymal Sperm Aspiration (PESA), which rely on random sampling of testicular tissue, micro-TESE employs a powerful operating microscope to identify and extract the seminiferous tubules that are most likely to contain sperm. This targeted approach results in a higher retrieval rate of motile and normal sperm, increasing the chances of successful fertilization during assisted reproductive techniques such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
Another advantage of micro-TESE is its minimally invasive nature. The procedure is performed through a small incision in the scrotum, which reduces the risk of complications and ensures a quicker recovery for the patient. Additionally, by using microsurgical techniques, the surgeon can precisely locate and extract the sperm-containing tubules, minimizing damage to surrounding tissues and increasing the chances of preserving future testicular function.
Furthermore, micro-TESE allows for more accurate diagnosis and tailored treatment options. By analyzing the testicular tissue under the microscope, the surgeon can assess the quality and quantity of sperm present. This information can help in determining the most suitable course of action for the patient, whether it is pursuing IVF with the retrieved sperm or considering other options such as donor sperm or adoption.
Microscopic Testicular Sperm Extraction also offers hope for men with non-obstructive azoospermia, a condition where there is a complete absence of sperm in the ejaculate. In many cases, these men still have small pockets of sperm production within their testicles, but they are not easily detectable without magnification. Micro-TESE allows for the identification and extraction of these hidden sperm cells, providing an opportunity for biological fatherhood.
In summary, micro-TESE is a significant advancement in the field of male infertility treatment. Its advantages include a higher success rate in retrieving viable sperm, minimally invasive nature, precise diagnostics, and tailored treatment options.