Various sperm retrieval techniques have been introduced in the niche of assisted reproduction technologies, among which TESE or testicular sperm extraction is a preferred option. Sperm extraction is recommended for men as a part of treatments like IVF. Sperm extraction is now applicable to both kinds of azoospermia, i.e. obstructive and non-obstructive. However, the pre-testing for non-obstructive azoospermia is a bit more elaborative. This is done to ensure that the sperm extraction is carried out with a greater degree of precision and precautions that are mandatory for non-obstructive azoospermia.
Testicular Sperm Extraction Basics
ICSI technology has made it possible to insert the extracted sperm in the oocyte (the female egg). Please note that sperm extraction may or may not be conducted in conjunction with ICSI or Intracytoplasmic Sperm Injection. In some cases, the fertility clinic might schedule the sperm extraction along with the oocyte retrieval to attempt fertilization on the same day. This is usually seen when obstructive azoospermia has been diagnosed. However, owing to a previous history of IVF failures or other sperm-related issues, like non-obstructive azoospermia, the clinic might freeze the extracted sperm sample for testing and use it at a later date.
What to Expect during TESE
TESE uses a standard biopsy method for extracting the testicular tissue. The male patient is prepped and prepared for the procedure. The patient is administered local or general anesthesia.
The attending specialist performs a basic scrotal exploration. This includes observing the testicular blood vessels present within the tunica albuginea (testicular tissue) through magnifying lenses. This approach also ensures that more spermatozoa (sperm cells) are accessed per biopsy. The greater visualization ensures that the blood vessels are clearly identified and unharmed, helping to avoid chances of vascular injuries and bleeding.
For accessing the testicular tissue in the chosen spot, an incision needs to be made. A minute surgical incision is made in the chosen spot devoid of circulatory network. Usually, the medial or anterior surface of testis is preferred for making the incision. Using a surgical instrument, a small sample of testicular tissue is extracted. The biopsy volume of most testicular samples is between 50 and 100 mg, but this can be higher.
The biopsied testicular sample is placed in a special kind of solution that is prepared by mixing a laboratory solution with tubal fluids extracted during the biopsy. This solution ensures that the sample is well-preserved in its natural environment. This testicular sample is then sent to laboratory of the fertility clinic where it is further dissected and processed for removing the mature/motile sperm cells.
What to Expect after TESE
The entire process is virtually painless, and there are negligible chances of bleeding or any other kind of surgical trauma. Extensive bandaging is not required and the patient is free to exit the clinic within a couple of hours after the anesthesia wears off. However, the patient might be asked to wait for some time in the fertility clinic. This is because many clinics choose to wait for quick feedback from their laboratory technicians regarding the quality of the biopsied sample and chances of a successful sperm extraction. If the sample doesn't seem good, another or multiple biopsies may be performed.