Micro Procedure, Huge Results
Microsurgical testicular sperm extraction (micro TESE) is a unique but effective surgical procedure used to retrieve sperm for fertility treatment purposes. Male infertility occurs when men are unable to conceive naturally despite repeated attempts. Severe cases can need innovative treatments or techniques to increase the chances of pregnancy, and micro TESE can help. The procedure retrieves sperm directly from the testicles, helping men with little or no sperm in the ejaculate. Combining micro TESE with effective medication helps doctors perform in vitro fertilization (IVF) or other fertility treatments.
Why would men need micro TESE?
Micro TESE can help men with severe infertility but still want to attempt to have a biological child. The procedure is most commonly used for azoospermia or a complete absence of sperm in semen. Micro TESE is specially used for non-obstructive reasons such as genetic abnormalities, testicular damage, severe hormone imbalances, or cancer treatment. Micro TESE surgically searches for and extracts sperm samples for IVF. Failed attempts to retrieve sperm using other methods is another typical use case for micro TESE. This is a more precise option that finds sperm while preserving as much tissue as possible. Another common example is to optimize IVF after multiple failed attempts. The fertility team may use intracytoplasmic sperm injection (ICSI) with sperm derived from micro TESE.
How is micro TESE performed?
Micro TESE is a detailed procedure that searches for sperm cells directly in the testicles. The surgeon will put the patient asleep using general anesthesia. A small incision is made in the scrotum to expose the testicles. Another incision opens the outer layer of the testicle. The surgeon then uses a high-powered microscope to inspect the seminiferous tubules within the testicle. Once sperm cells are identified, samples of testicular tissue are removed and passed to the fertility team. If no sperm is found, the surgeon will examine other areas of the testicle or repeat the process with the second testicle. Once the surgeon acquires enough samples, the incisions are closed for the patient to begin recovery.
Medication and micro TESE
Medication can help to optimize hormone levels and sperm health before using micro TESE. The goal is to acquire as many healthy sperm as possible during the procedure. Stimulating sperm production using targeted medication may increase success rates. Oral hormone medication like clomiphene citrate can improve sperm quality when used consistently. By increasing the release of hormones responsible for sperm production, fertility teams may potentially find more sperm. Injectable human chorionic gonadotropin (hCG) can directly improve hormone production, such as testosterone. Other possible medications include anastrozole, which prevents topterone from converting to estrogen. The fertility team will work with pharmacists to provide the right formulations for optimal results.
Medication to avoid
Some medications or supplements negatively impact sperm production and would make micro TESE unsuccessful. Doctors will recommend stopping or changing these drugs to improve sperm development and health. Exogenous testosterone supplements shut down the body’s ability to create testosterone and other hormones necessary for fertility. Medications used for hair loss like finasteride may reduce sperm quality in some men. Antidepressants and opiates are other typical medications to avoid. Recreational drugs and alcohol also impact sperm health. Perform a medication review with a pharmacist and fertility specialist to minimize any dangers to sperm health.
What’s next with micro TESE?
Successful micro TESE means the fertility team has viable sperm to use for fertility treatment. An embryologist can use a single sperm for each available egg to perform ICSI. The resulting embryos can then be used for IVF cycles. Micro TESE is valuable for men with severe male infertility, especially those with severely low or no sperm count. Proceeding with micro TESE is a major decision that must consider all health factors. Work with all experts to create a plan that combines effective sperm extraction and medication strategies.
