Micro-TESE is a sperm harvesting technique. The term sperm aspiration means any surgical procedure
performed by a physician for the purpose of obtaining viable sperm for use in fertility procedures. Sperm
retrieval techniques are typically performed on men who do not have sperm present in the ejaculatory fluid
or who are unable to ejaculate. The sperm that are collected via sperm aspiration are intended
specifically for use in a procedure called Intracytoplasmic Sperm Injection (ICSI). ICSI involves the
injection of a single sperm directly into an egg for the purpose of conception. Today, reproductive
medicine has developed a number of approaches to sperm aspiration, depending on the man’s specific set of
fertility concerns. Especially for men with NOA, Micro-TESE can both assess the presence of usable sperm
as well as preserve it for later use in an IVF/ICSI procedure. In doing so, this advanced technology
renders antiquated approaches like testicular mapping (hyperlink to testicular mapping page here)
procedures substandard and in many cases, dangerously unnecessary.
Sperm aspiration is intended for men who suffer from the most extreme male infertility types. These include
men with no sperm in their ejaculate (a condition referred to as Azoospermia) and men who have no live,
moving sperm (a condition known as Necrospermia).
What is Micro-TESE and How Does it Work?
Micro-TESE is considered the gold standard procedure chosen by today’s expert male fertility experts for
men who want to become biological fathers but have a condition called Non-Obstructive Azoospermia (NOA).
Modern advances in reproductive technology allow for the harvesting of viable sperm directly from the
testicle. Many men with NOA who have very poor sperm production often have some pockets located inside the
testicles in which viable sperm are being produced. The medical challenge is to find those pockets in a
safe, effective, cost and time efficient way. Micro-TESE achieves these goals. Through the use of this
micro-surgical procedure, the male fertility expert can observe the inside of the testicle and select the
best candidate areas to examine for sperm production.
Once a promising section is identified, the physician will remove a small piece of testicular tissue for
further examination under a special microscope. The tissue is then carefully examined to find sperm to be
used for IVF/ICSI.
The testicular tubules that produce sperm are microscopic, meaning that they cannot be seen by the naked
eye. But today’s technology has created exciting opportunity to view these tubules using an operating
microscope whereby the tubules can be magnified 10X during the procedure. This technology allows the male
fertility expert to remove the “better” or more normal looking tubules – which are also usually the ones
that produce the healthy sperm needed for IVF/ICSI.
Finding a male fertility expert who has significant experience in the Micro-TESE technique is crucial. When
an experienced physician has performed so many of these procedures, he or she has cultivated an exceptional
ability to rapidly and accurately locate and remove these more promising tubules.
Once the tissue samples are removed, the tubules are opened in a carefully controlled way and the search
for usable sperm begins by viewing the specimens under the laboratory microscope. Though the tissue sample
obtained may seem small, it can take hours to search for sperm in these specimens. Micro-TESE may seem like
an extremely involved and tiresome process, but it is very thorough and incredibly important. But perhaps
one of the greatest advantages of Micro-TESE is that once viable sperm are found, they can then be incubated
and injected into awaiting eggs or frozen for future injection.
The advanced Micro-TESE technique allows the skilled male fertility specialist to direct the examination to
the best areas of the testicle, thus increasing the chance of finding sperm while removing smaller amounts
of tissue than a random biopsy. This increases precision and decreases the risk of causing accidental damage
to the testicular tissue. When compared with the Micro-TESE procedure, Random Testicular biopsies are highly
unpredictable in the potential yield of sperm and an inaccurate way to best assess sperm production in the
testicle. Simply put, it is impossible for a doctor to find healthy pockets of sperm by observing the
exterior of a testicle. That approach is best described as “blind luck.”
Micro-TESE is a technologically-advanced approach to sperm aspiration and it requires the incredible skill
and understanding of an expert micro-surgeon who is completely familiar with testicular tissue. The
combination of a state-of-the-art operating microscope, proper and careful dissection of the testicular
tubules and having experienced personnel available to look for viable sperm can mean the difference between
reproductive success and failure for many couples.
The great advantage of Micro-TESE is that it can be performed as both a diagnostic procedure first and at
the same time be therapeutic as well, because it takes into account the possibility that if usable sperm are
found, they can be frozen and stored for future use in an IVF/ICSI procedure. Micro-TESE can also be timed
with an egg retrieval/IVF cycle so that the sperm are injected into the eggs without having to freeze them
first. This is a great benefit because sometimes, freezing of sperm from men with sperm production problems
(like NOA) can be difficult although the pregnancy rate using fresh versus frozen sperm taken from men with
NOA are exactly the same.
The chance of locating viable sperm using the Micro-TESE procedure is greater than 60%. By comparison, this
is double the chances of finding sperm by non-microsurgical or testicular biopsies taken by professionals
who aren’t male fertility experts or trained micro-surgeons. Though performed by a small number of male
reproductive surgeons, Micro-TESE is a great advance in male reproductive surgery today.
Different from the Micro-TESE procedure but often used synonymously, testicular microdissection is a sperm
retrieval technique that entails opening the scrotum, removing the testicle from the sac, making a large
incision in the testicle to open it in half. Unfortunately, sometime this aggressive approach can cause
unnecessary damage to the testicle during this procedure by being overly zealous in the search for usable
sperm. This possible risk has frightened many patients away from what is otherwise an effective procedure.
Only in the most severe cases does a testicle need to be completely opened. Dr. Werthman has developed a
technique to accomplish the same results by beginning with a very small incision whereby sperm can be
located and retrieved with minimal trauma to the testicle and surrounding tissue. Sometimes sperm cant be
found with the minimally invasive approach and a microdissection is warranted but by starting small, there
is less chance of unnecessary damage and quicker recovery and less discomfort.
Due to his care, experience and expertise, Dr. Werthman in Los Angeles has as yet never had a patient with normal
testosterone prior to the procedure need to later undergo testosterone therapy due to a Micro-TESE
procedure. Men who start with low testosterone levels will likely need some sort of hormone replacement
therapy regardless of the procedure.
Our philosophical approach to any surgery is to make thing as simple and easy for the patient as possible,
with the shortest recovery time and inconvenience while trying to maximize successful outcomes for each