TESA / TESE / Micro-TESE
Couples facing azoospermia (no sperm in the ejaculate) still have hope. In many cases the testes still produce sperm but transport is blocked (obstructive azoospermia) or production is very low (non-obstructive). Surgical sperm retrieval (TESA, TESE, Micro-TESE) recovers sperm directly from the testicle and the retrieved cells are used for ICSI to achieve pregnancy.
TESA vs TESE vs Micro-TESE
TESA (testicular sperm aspiration) uses a fine needle to aspirate fluid from the testicle and is highly successful in obstructive azoospermia (e.g. post-vasectomy). TESE (testicular sperm extraction) takes small tissue samples through a small incision in several testicular regions. Micro-TESE, the most advanced technique, is performed under an operating microscope to identify and remove the seminiferous tubules that contain sperm; it offers the highest yield in non-obstructive azoospermia (40–60% sperm-retrieval rate).
Procedure and Anaesthesia
The procedure is performed under general or spinal anaesthesia and lasts 30–60 minutes. The female partner’s eggs are retrieved on the same day, and any sperm recovered is injected into the eggs by ICSI. If extra sperm is obtained it can be cryopreserved for future cycles, avoiding repeat surgery.
Indications
Obstructive azoospermia (post-vasectomy, congenital absence of vas deferens), post-infectious or traumatic obstruction, hypogonadotropic hypogonadism unresponsive to medical therapy, non-obstructive azoospermia (Klinefelter syndrome and others) and previous failed TESE attempts are indications for Micro-TESE.
After the Procedure
Most patients are discharged the same or next day. Swelling and mild bruising may last a few days. Intercourse and heavy exercise are postponed for 1–2 weeks. Testosterone levels are monitored; supplementation is rarely needed. Even very small numbers of viable sperm are enough for successful ICSI.
Treatment Steps
- 1Pre-operative Assessment
- 2Surgical Procedure
- 3Sperm Extraction
- 4Sperm Processing
- 5ICSI Procedure
Who Is It For?
- Post-vasectomy obstructive azoospermia
- Congenital absence of vas deferens
- Post-infectious/traumatic obstruction
- Klinefelter and other non-obstructive azoospermia
- Previous failed TESE
Frequently Asked Questions
Is Micro-TESE painful?
The procedure is performed under anaesthesia, so it is not painful. Mild swelling and tenderness can last a few days.
What if no sperm is found?
Donor sperm is the back-up plan. Patients are counselled about this possibility upfront at Doğuş IVF Center.
Does testosterone drop after TESE?
A transient decrease is possible and usually normalises within six months. Patients with Klinefelter may need supplementation.
Is a small number of sperm enough for many eggs?
Yes. Even few sperm can fertilize many eggs by ICSI.