استخراج اسپرم از بیضه به روش میکروسکوپی (Micro TESE)

Pooyesh Fertility Clinic

Microsurgical Testicular Sperm Extraction (Micro-TESE)

 

What is Micro-TESE?
Micro-TESE is a microsurgical sperm retrieval technique in which sperm are extracted directly from the seminiferous tubules of the testes under high magnification.

This advanced method is especially used for men with non-obstructive azoospermia (NOA), where the testes produce very few or no sperm.

Advantages of Micro-TESE

  • Higher accuracy in sperm retrieval: The use of a surgical microscope allows the urologist to precisely identify tubules that are more likely to contain sperm. This significantly increases the chances of finding sperm compared with conventional open procedures such as TESE or FNA.
  • Minimal testicular damage: Because the procedure involves small, delicate incisions, Micro-TESE causes less harm to testicular tissue than traditional open surgery.
  • Lower complication rate: Micro-TESE is associated with fewer side effects compared with standard TESE.

How the Procedure is Performed

  • The surgery is performed in the operating room under general anesthesia using a surgical microscope.
  • A small incision is made in the testis, and tiny samples of tissue are carefully taken.
  • The tissue is immediately sent to the IVF laboratory for sperm isolation.
  • Retrieved sperm may be used the same day for ICSI (Intracytoplasmic Sperm Injection) or cryopreserved (frozen) for future assisted reproduction treatments.
  • The procedure is short, considered outpatient surgery, and does not usually require hospital admission.

When is Micro-TESE Recommended?

Micro-TESE is generally indicated in cases such as:

  • Normal testosterone levels but no sperm (or very few sperm) in semen analysis.
  • Persistent azoospermia after medical or hormonal treatments, provided testosterone remains within normal limits for at least 4 months.

Success Rates

  • Success depends on several factors including age, underlying cause of infertility, and sperm quality.
  • In approximately 50–60% of cases, sperm can be successfully retrieved.
  • If sperm are not found during the first attempt, the chance of success in a repeat procedure decreases to 7–10%.

Risks and Possible Complications

Although Micro-TESE is considered safe, potential risks include:

  • Mild to moderate pain at the incision site
  • Minor bleeding
  • Infection (rare)
  • Scarring at the incision site
  • Local discomfort

 

Pre-Procedure Instructions

  • Shower and shave the genital and abdominal area.
  • Stop taking Aspirin, Warfarin, or Heparin (if prescribed), as directed by your physician.
  • Remain fasting for at least 8 hours before surgery.
  • Remove jewelry (rings, watch), eyeglasses, dentures, hearing aids, lenses, or prosthetics before entering the operating room.
  • Empty your bladder immediately before the procedure.
  • Inform your doctor and nurse if you smoke or use recreational drugs. Avoid smoking for at least 24 hours before surgery.

 

Post-Procedure Care

  • Begin with fluids about 6 hours after surgery, then return to a normal diet as tolerated.
  • Wear supportive underwear for 2 weeks.
  • Remove the dressing and shower 48 hours after surgery; no further dressing is usually required. Sterile gauze may be used if there is minor discharge.
  • Contact your doctor if you experience severe testicular swelling, heavy bleeding, fever, or chills.
  • Sutures are absorbable and do not need removal.
  • Sexual activity may be resumed one week after surgery.
  • Follow up with the andrology laboratory the day after surgery for biopsy results.
  • Visit your doctor one week post-procedure for evaluation.