Testicular Sperm Extraction (TESE)

Sperm retrieval is any way used to get sperm for fertility purposes.

There are many ways to get sperm. The method used depends on why sperm aren’t in the semen, what the patient wants, and the surgeon’s skill.

What Happens under Normal Conditions?

At the base of the penis, sperm and testosterone (male hormone) are made in the scrotum’s 2 testicles. The sperm leave the testicles through a coiled tube called the epididymis. They stay there until they’re ready to be used. Each epididymis is linked to the prostate by a tube called the vas deferens. This tube runs from the scrotum into the groin, then the pelvis and behind the bladder. There, each vas deferens joins with a seminal vesicle and forms the ejaculatory duct. For ejaculation, sperm passes through the ejaculatory ducts to mix with fluid from the seminal vesicles, prostate, and other glands to form semen. The semen travels through the urethra and comes out the end of your penis.

When Is Sperm Retrieval Recommended?

Sperm retrieval is done when pregnancy is the goal but not possible without help. It is for men who have little or no sperm in the semen, or men who aren’t able to ejaculate. In these cases, sperm can be collected from other parts of the reproductive tract. For good pregnancy rates, sperm retrieval is used with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

In vitro fertilization (IVF) is the process of combining an egg and sperm in a laboratory dish for fertilization. This combined sperm and egg are called an embryo. The embryo is transferred to the uterus for development.

Intracytoplasmic sperm injection (ICSI) is an IVF process where a single sperm is injected directly into an egg.

The way to check for sperm in the semen is to do a semen analysis. Your urologist will look at your semen under a microscope. No sperm in the semen (“azoospermia”) may mean sperm retrieval is needed.

The 2 main types of azoospermia are obstructive azoospermia and non-obstructive azoospermia.

Testicular Sperm Extraction (TESE)

TESE is often used to diagnose the cause of azoospermia. It can also get enough tissue for sperm extraction. The sperm can be used fresh or frozen (“cryopreserved”). TESE is often done in the urologist’s office with a nerve block. A nerve block is an anesthetic injected into nerves to treat pain. The nerve block will “turn off” a pain signal from a specific location; in this case, from the testis. Or, TESE can be done under anesthesia in a surgical center. It involves one or several small cuts in the testes.

Microsurgical Testicular Sperm Extraction (Micro-TESE)

Micro-TESE is done only for non-obstructive azoospermia. The outer cover of the testicle is opened and the inside is checked. Your urologist can see areas more likely to be making sperm. This technique is done by a Urologist trained in microsurgery. Micro-TESE is usually done in the operating room. This way, more of the testis is examined, but less tissue is removed. There’s also less damage to the blood vessels. Some feel Micro-TESE offers a better chance of finding sperm in the patient with non-obstructive azoospermia.