Microscopic Testicular Sperm Extraction (MicroTESE) in Iran

What is micro-TESE?

If a man can’t release or make enough healthy sperm, Microscopic Testicular Sperm Extraction (microTESE) is done to treat male infertility. In this procedure, sperm is directly retrieved from the testicular tissue of the man. The goal is to obtain the best quality sperm available, enough to fertilize the egg of a woman while minimizing the damage to the male reproductive organs.

How is Micro-TESE performed?

During this procedure, the surgeon makes a small incision in the testis and removes a small amount of tissue, then they search for healthy sperm in the tubules of the testis using an operating microscope while the patient is under general anesthesia. It takes 2-3 hours along with the maximum amount of effort and precision. Any sperm found through microTESE will be used for IVF or ICSI in order to enable the man to biologically become a father.

The patient can go home on the day of the procedure and is able to resume normal activities within one or two weeks.

Who can be a candidate for Micro-TESE?

Patients with non-obstructive azoospermia for which there’s a low likelihood of finding sperm cells in the testicles, should be considered to do the micro-TESE surgery.

The medical term for when there is no sperm in the ejaculate is “azoospermia”. It can be either ‘obstructive azoospermia’ (OA) when there’s a blockage preventing sperm from entering the semen, or ‘nonobstructive azoospermia’ (NOA) when the sperm production by the testis is decreased.

After azoospermia is confirmed, genetic and hormone tests are performed to declare whether the individual is a candidate for surgery.

Micro-TESE success rates

Men with OA:

The chance of successful retrieval of sperm approaches over 90% in these patients.

Men with NOA:

The success rate is quite favorable to men. In fact 60 percent of the time during the micro-TESE procedures doctors are able to find good sperm usable in fertility treatment such as IVF, ICSI, or freezing the sperms for later use.

How to prepare for Micro-TESE?

• Any medication that thins the blood should be avoided for 5 days before the surgery since they may cause extra bleeding during and after the procedure. For example aspirin or aspirin like drugs like ibuprofen.
• The scrotal area should be shaved the same day in order to help minimize the chance of infection.
• Normally if azoospermia is confirmed, sexual abstinence is not required before the procedure.
• Arrange for someone to drive you back home.

The Day Before

• Do not eat or drink anything after midnight.
• Take a shower the night before your surgery. Use clean towels to dry off and wear clean clothes.
• Do not use deodorant, cologne, lotion, etc.

Micro-TESE recovery

The procedure will not impede you from sitting or walking. There are some common symptoms that do not require the doctor’s attention, like slight color change and swelling. Also nausea, constipation, general body pain, sore throat which will usually go away on their own within 48 hours.

• Drink lots of water and stay hydrated.
• Resume a normal, well-balanced diet when you go back home.
• If you’re not feeling normal, start with easy to digest food such as soup or broth. And avoid greasy or spicy food.
• If your doctor prescribes medicine for pain, take it exactly as directed.
• Sexual activity or masturbation should be avoided for 3-4 weeks. 
• Use cold packs to reduce swelling. Do not put the cold pack directly on your skin.
• You may resume normal and light activity after 48 hours when you feel better.
• More vigorous activities such as jogging and weight lifting can be resumed after 3-4 weeks. Listen to your body and if something causes you discomfort, slow down or stop and rest.
• Your incisions will be closed with stitches and dissolve on their own. Usually it takes 2-3 weeks.

What are the side effects of Micro-TESE surgery?

Complications after this procedure are rare but contact your doctor if you experience these risks: 

• Postoperative skin or testicle infection
• Bleeding
• Pain or discomfort
• Signs of a hematoma (bleeding under the skin): Severe bruising (black and blue bruise) especially if you also have throbbing pain or there’s a bilge around your scrotum
• Testicle damage (which is very rare)

What is the difference between c-TESE and micro-TESE?

In c-TESE, the surgeon extracts a sample tissue from the testicles based on their own discretion, without the help of an operating microscope. Therefore tissue collection is done ‘blindly’, without the help of magnification to choose the most suitable tissue. Unlike micro-TESE, this is a ‘closed’ surgical approach and an outpatient procedure that takes less time than micro-TESE (60 to 90 minutes) and you’d be under mild sedation, local or general anesthesia. 

Micro-TESE is less invasive, deals less damage to the microscopic blood vessels and testosterone producing cells. Your doctor will advise which approach would suit your condition better.

How are TESA and micro-TESE different?

Testicular sperm aspiration (TESA) is performed by sticking a needle in the testis and aspirating fluid and tissue with negative pressure. The patient will be under local anesthesia or sedation. This is also an outpatient procedure and a less invasive approach than biopsy. You might only experience discomfort for a few days afterwards. If enough sperm is not provided by TESA, then the patient is recommended to undergo testicular biopsy procedures like c-TESE or micro-TESE.