Testicular sperm extraction (TESE) or testicular sperm aspiration (TESA) is a simple procedure to obtain sperm in men with obstructive azoospermia (i.e. men who have had vasectomies). These men have normal sperm production but a blockage exists that does not allow sperm to reach the semen. A TESE or TESA can be performed in your doctor’s office under local anesthesia or in the operating room under general anesthesia.
This procedure is done under general anesthesia, or conscious sedation where you are asleep. A very small needle is used to completely numb your testicle and the skin around it. We then make a very small incision in your scrotum and testicle so we can extract a small amount of sperm from your testicle. We can’t use this procedure for men who have non-obstructive azoospermia because TESE doesn’t extract as much tissue as the microTESE procedure does.
A very small needle is used to completely numb your testicle and the skin around it. We also offer this procedure under general anesthesia or conscious sedation where you are asleep. A larger needle is then inserted into the testicle and tissue (tubules) where sperm are aspirated through a syringe. No incision is made during this procedure. A similar procedure can be performed to aspirate sperm directly from the epididymis: percutaneous epididymal sperm aspiration (PESA) or microsurgical epididymal sperm aspiration (MESA).
*Please note that any sperm we find during these procedures must be used for IVF (in-vitro fertilization). This is because sperm inside your testis hasn’t learned how to swim yet, so it can’t fertilize an egg if it’s placed inside the uterus.
Non-obstructive azoospermia (NOA) is a common cause of male infertility in which men do not produce enough sperm to have a detectable amount in their semen. A microsurgical testicular sperm extraction or “microTESE” is a surgery that can be performed to extract the small numbers of sperm that might be produced in the testicles. This surgery is recommended for men who have adequate testosterone levels, or for men who’ve taken medications to correct their testosterone for at least four months, but still aren’t releasing any sperm during ejaculation. During microTESE procedures, doctors can find sperm approximately 50 percent of the time.
In men with non-obstructive azoospermia, we do not recommend performing fine needle aspiration or biopsy before microTESE because studies have shown that microTESE yields the highest sperm retrieval rate and causes the least amount of damage to the testis. For microTESE to be successful, you need to have a skillful surgeon and an excellent andrology technologist searching for sperm. During your microTESE procedure, an andrology lab technician will be in the operating room to analyze the extracted tubules for sperm. If the technician finds sperm, the specimen will be frozen so the sperm can be used in future reproductive treatments, like in-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI).
While completely asleep under general anesthesia, your doctor will make a very small (2-3cm) incision in the scrotum and in each testicle. Under a high-power microscope, your doctor will then look for seminiferous tubules in each testicle that are swollen and may contain sperm. During the surgery, our andrology technologist will examine the tubules under a microscope to look for sperm. The number of tissue samples taken will depend on whether the technologist finds sperm, and if so, how many are found. The testicle and skin incisions are then closed with stitches. The suture in the scrotum will dissolve on its own and will leave little or no scarring. If our technologist finds sperm in your tissues, the sperm will be frozen and can be used for in-vitro fertilization.
Most men are surprised by how little pain they have after this surgery. The scrotum is one of the fastest healing parts of the body. Most men use an ice pack for the first 24 hours after the surgery and then forget to take the pain medications they are sent home with. We ask men to avoid sex, masturbation, or vigorous exercise for 10 days after the surgery.