Testicular sperm extraction, or TESE, is considered among the safest of sperm extraction methods. It is widely used in IVF treatments where the male IVF patient is incapable of providing healthy sperm samples. Testicular sperm extraction is an undemanding procedure that can be performed on an outpatient basis. The entire procedure is done under local anesthesia. It has emerged as the most favored treatment for some typical medical conditions in men struggling with azoospermia or the severe lack of sperm in the semen. However, before opting for this treatment, its various applications should be fully understood.
Within the niche of azoospermia, there are two basic categorizations. This refers to obstructive and non-obstructive azoospermia. Obstructive azoospermia isn't always resolved through sperm extraction. This is because this condition refers to an internal obstruction of the testicular pathway through which the sperm progresses. If the obstruction can be alleviated through some alternative treatment, there is no need to extract the sperm. Surgical intervention for causes of obstructive azoospermia like a blocked epididymis is quite common. Similarly, the blockage of the vas deferens can be resolved without opting for sperm extraction.
This is among the most misinterpreted of subjects regarding sperm retrieval through TESE. Please note that vasectomy causes a form of obstructive azoospermia that is likely to be resolved through surgical intervention that includes vasectomy reversal. The surgical process of reversing vasectomy to ensure that the normal pathway of sperm production and maturation is restored is Vasovasostomy. However, there are many cases wherein even after surgical correction, enough spermatozoa are not found in the seminal fluid samples. Here, TESE is recommended for vasectomized men.
In a stark contrast to obstructive azoospermia, non-obstructive azoospermia or NOA doesn’t put forth many options, i.e. sperm extraction is necessary here. This is essentially because patients of NOA struggle with the total absence of sperm in their ejaculated fluids. Even if the semen contains a minute concentration of sperms, they are of little use from the perspective of fertilizing the female egg. Cases of NOA typically qualifying for sperm retrieval through TESE include:
- Sertoli-only Syndrome—men diagnosed with non-obstructive azoospermia (NOA) having only Sertoli cells in the testicular tubules suffer from a severe impairment of sperm genesis. This condition is also called Sertoli cell-only Syndrome. Here, the supporting cells or Sertoli cells needed for sperm maturation are present within the testes but the actual, sperm-generating germ cells are absent. Maturation arrest refers to a condition in which Sertoli cells are accompanied by some immature germ cells that are incapable of producing potent sperm cells.
- Hypospermatogenesis—this is a serious abnormality in the process of sperm generation that cannot be cured with prescription medications or surgeries. This condition refers to an inherent lack of germ cells in the seminiferous tubules. As a result, the spermatozoas (sperm cells) may be absent or present in very minute volumes.
- Cryptorchidism—this refers to a condition of absence of one or both testes in the scrotum sac. This usually happens during the fetal development wherein the testes don’t descend or move towards their usual position in the scrotum sac. This condition is also established if one testis is present, but it seems unusually soft and is devoid of sufficient germ cells (and the blood tests reveal high FSH levels).