To perform in vitro fertilization (microinjection) in azoospermic men who have no sperm in their ejaculate, the process of obtaining sperm from the testicles of the patient by surgical methods is called m-TESE.
Normally, if sperm will be searched directly from the testicle and azoospermia is clear, sexual abstinence is not required before the procedure.
A small amount of sperm can be found in the ejaculate in some patients. This condition is called "cryptozoospermia" or "virtual azoospermia". If the doctor thinks it necessary, a single or consecutive sperm sample can be taken from the patient before the m-TESE procedure.
According to sperm count and quality, m-TESE can be applied in couples with recurrent reproductive failure, male patients with severe sperm motility problems (total immotile sperm), and cases with insufficient sperm retrieval with TESA before reproductive cycles.
Over the last decade, fertility technology has advanced significantly, and men who were previously considered sterile are now able to father biological children of their own. In In-Vitro Fertilization (IVF) using Intra-Cytoplasmic Sperm Injection was the first of these breakthroughs. In India, males with very low sperm counts undergo a micro TESE procedure, giving them the option to become biological fathers.
There are two main tasks of testicle: sperm production and hormone synthesis. Although m-TESE is performed under the operation microscope, it is a surgical procedure and damages the testicular tissue. The first m-TESE always has the highest success rate. Finding sperm in the first application does not always mean that sperm will be obtained in the following operation. If there is a local focus and this area is taken in the first application, a new focus will not be formed. Therefore, there is no chance of obtaining sperm in m-TESE again. In the male who were sperm was obtained in the first m-TESE, sperm retrieval rate in repeated m-TESE is 80-85%. On the other hand, in cases where the first m-TESE fails, 20-30% sperm can be obtained in a m-TESE made by experienced hands.
In azoospermia cases, there is peripheral chromosome abnormality in 5-10% of cases and chromosome-Y deletions in 11-15% of cases. Therefore, genetic tests should be done before m- TESE.
Criteria Showing the Probability of Obtaining Sperm m-TESE Before m-TESE, the patient evaluated carefully with is history and performed detailed physical examination. However, none of these are determinative for sperm retrieval rate. Sperm can be found even in cases of undescended testicle, mumps infections affecting the testicles, and cases undergoing cancer treatments. There is not any relationship between testicular size and sperm retrieval. Additionally, serum hormone levels including FSH, LH, Testosterone, Inhibin B are insufficient to determine sperm recovery.
For males who don't have a sufficient amount of sperm in their ejaculate fluid, the option of going straight to the testicle and looking for any little pockets of sperm production may be a possibility. Microdissection testicular sperm extraction or Micro TESE is the term for this procedure. This causes almost zero harm to the testicular structure. However, there might be some side effects, such as blood supply issues caused by the cutting of microscopic blood vessels. It also appears to boost the amount of sperm that can be extracted for IVF procedures.
Microdissection Testicular sperm extraction is a surgical sperm collection operation used in the treatment of infertility in men who have no sperm in their ejaculate due to testis dysfunction (non-obstructive azoospermia). Micro TESE Procedure involves a physical biopsy of the testicles in which the cell to be removed is identified using an advanced operative micro dissecting lens.
The testicle is opened and examined under operational magnification to find any little spots within the testicle where sperm are being created. Multiple areas are retrieved and evaluated right away to check if there are any sperm present. Any sperm discovered can only be utilized for IVF and Intracytoplasmic Sperm Injection (ICSI).
The treatment can take anywhere from one to four hours. There will be a need for general anesthesia. In order to improve surgical sperm retrieval rates, some men are put on hormonal medicine for three months prior to the Micro TESE Procedure.
Antibiotics and painkillers are recommended after the surgery. This treatment should be continued within the recommended time. After the procedure, the patient may be felt pain in the wound and testicle for 1-2 days.
During the post-operative period, it is necessary to avoid compelling movements (such as long walking, heavy lifting). The patient can take shower 2 days after the operation. It is recommended to use special underwear (suspender) for 10-15 days to prevent edema in the testicles after surgery. If he is using anti-coagulant drugs, they are appropriate to stop these drugs one week before the surgery and not to use them until one week after.
During the Micro TESE, experts first use the TESA technique to extract sperm. If that fails, they move on to mapping, and if sperms are still not found, they resort to micro TESE. Because the micro-TESE method does not guarantee that sperm will be detected, professionals frequently have a "back-up plan." Many couples choose donor sperm as a backup option, which has been pre-selected and can be utilized for fertilization if sperm are not identified during the micro TESE procedure.