Testicular Sperm Extraction

Meaning

Testicular Sperm Extraction, TESE, is a precise surgical procedure to retrieve spermatozoa directly from testicular tissue. This method is employed for men diagnosed with azoospermia, the absence of sperm in the ejaculate, offering a crucial pathway for biological fatherhood.

Context

TESE operates within male reproductive health and assisted reproductive technologies (ART), addressing severe male infertility. It is considered when conventional sperm retrieval methods are unviable due to obstructive or non-obstructive conditions impacting testicular sperm production. Its role is pivotal for subsequent in vitro fertilization (IVF) procedures.

Significance

The clinical importance of Testicular Sperm Extraction lies in providing a viable option for couples facing male infertility previously considered untreatable. By directly accessing testicular sperm, TESE enables individuals with azoospermia to participate in treatments like ICSI, improving prospects for biological pregnancy. This procedure has transformed male infertility management.

Mechanism

During TESE, a surgeon makes small scrotal incisions to access the testicle, carefully excising tiny seminiferous tubule tissue samples. These fragments are processed in an embryology laboratory, where embryologists isolate and identify individual spermatozoa under a microscope. Retrieved sperm are typically non-motile and prepared for immediate ICSI use.

Application

TESE is routinely applied for men with non-obstructive azoospermia (NOA) or obstructive azoospermia (OA) when other less invasive retrieval techniques are unsuitable. It is invariably paired with ICSI as part of an IVF cycle, as retrieved sperm are usually few and may have reduced motility, necessitating direct oocyte injection.

Metric

The primary metric for assessing TESE’s immediate success is the successful identification and retrieval of viable spermatozoa from excised testicular tissue. Post-retrieval, the laboratory evaluates the number and quality of sperm obtained. Ultimately, clinical efficacy is measured by fertilization rates after ICSI and subsequent live birth rates, reflecting the procedure’s contribution to reproductive outcomes.

Risk

While TESE is generally well-tolerated, potential risks include localized discomfort, swelling, bruising, or hematoma at the surgical site. There is a small risk of infection or persistent pain. In rare instances, repeated procedures could impact testicular endocrine function, though minimized by surgical technique. Not retrieving sperm remains a significant emotional risk for patients.