If you (or your male partner) either have no sperm present in your semen, or are unable to ejaculate, a doctor may collect live sperm by removing some testicular tissue in a procedure known as testicular sperm extraction (TESE). Your doctor can then use the retrieved sperm in an in vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI) procedure.
To determine if your semen has sperm, your doctor will first perform a semen analysis. For this you will most likely will ejaculate into a sterile cup that your doctor provides. Your doctor then sends the semen sample to a lab that will analyze it under a microscope, looking specifically at the amount of sperm and its quality. If no sperm is present—a condition called azoospermia—testicular sperm extraction (TESE) may be called for.
What is testicular sperm extraction?
Doctors can extract sperm from the male reproductive track through a variety of different methods, with the choice dependent on a number of factors, including your preference, your surgeons skill and the cause behind the lack of sperm in the semen. TESE is just one technique that may be used to retrieve sperm.
In a TESE procedure, your surgeon collects sperm directly from your testes. It is done when a man has no sperm in his semen and other options for obtaining sperm will not work.
You may have sperm extracted in this way if:
- Your testes do not make enough sperm to show up in your semen
- Scar tissue or other blockage is preventing sperm made in the testes from reaching the semen
- You are scheduled to have a medical procedure, such as cancer treatment, that may lower your sperm count or affect its quality
During testicular sperm extraction, your doctor removes a small amount of tissue from one or both testicles; checks it for mature, healthy sperm; and then, if enough healthy sperm are present, uses the sperm in an IVF or ICSI procedure. The tissue may also be frozen in a sperm bank, allowing for the sperm within it to be used at a later date.
Who is a candidate for testicular sperm extraction?
Because TESE is a surgical procedure, other less invasive methods may be attempted first, such as washing the sperm or retrieving sperm with a small needle (aspiration) from the testes or the tubes (vas deferens or epididymis) that carry the sperm to the penis. When these attempts do not work and TESE is the alternative, there is usually a condition preventing sperm from reaching the semen.
Conditions that might require testicular sperm extraction include:
- Obstructive azoospermia: The testes may produce enough sperm but a blockage in the tubes that carry sperm from the testes keeps the sperm from reaching the semen.
- Non-obstructive azoospermia: The testes do not produce enough healthy sperm for a man to get his partner pregnant through sexual intercourse.
- Ejaculation problems: This includes retrograde ejaculation, when semen travel backwards into the bladder instead of out of the penis. Some men may also have difficult ejaculating at all (anejaculation), although erections may be normal.
How is the procedure performed?
Testicular sperm extraction is done with local or general anesthesia to help reduce discomfort. During the procedure, you doctor will:
- Make a small cut (incision) in the scrotum
- Examine the testes to look for regions that are likely to contain sperm. This is sometimes done with a small surgical microscope.
- Remove a small amount of tissue (biopsy) from your testes
- Close the incision in the scrotum with stitches (sutures)
After the procedure, surgical staff will apply dressings to the scrotum, along with a scrotal support (compression bandage), to keep the bandages in place and to minimize discomfort during healing.
Tissue samples taken from the testes will be sent to a laboratory or sperm bank to be examined. If healthy sperm are found, sperm may be used immediately for IVF or ICSI, or frozen and stored for later use.
What is recovery from the procedure like?
For a few days after the procedure, you may have slight tenderness and pain in your scrotum. Your doctor may prescribe a pain medication to relieve the discomfort. You may also have some bruising on your penis and scrotum, which should go away within a week. Your doctor will provide you with care instructions to help you recover.
What are the risks of testicular sperm extraction?
The risks of testicular sperm extraction are low, but include:
- Slight tenderness and pain in your scrotum for a few days (common)
- Mild bruising on the penis and scrotum, which should go away within a week (common)
- Infection in the area of the incision (rare)
- Damage to the testes when multiple tissue samples are taken (rare)
- Injury to nearby tissue or organs (rare)
Is testicular sperm extraction covered by insurance?
Some insurance companies will cover testicular sperm extraction if it is performed along with other treatments, such as in vitro fertilization. However, health insurance coverage for fertilization procedures vary with both the company and plan. To be certain what your plan will cover, contact your insurance provider before scheduling any type of treatment.
Contact a fertility specialist near you today for more information.
Updated August 2014