Microsurgical Testicular Sperm Extraction (microTESE)

What is microsurgical testicular sperm extraction?

Microsurgical testicular sperm extraction (microTESE) is a surgical male infertility treatment. It takes male reproductive cells (sperm) directly from the testicular tissue in your reproductive system. Your testicular tissue is in your testes (testicles).

The goals of the microTESE procedure are to:

• Obtain the best quality sperm.
• Get enough sperm to fertilize a healthy female reproductive cell (egg).
• Minimize damage to your reproductive organs.

Another name for microsurgical testicular sperm extraction is microdissection testicular sperm extraction.

What does microsurgical testicular sperm extraction treat?

Healthcare providers often recommend microTESE to treat male infertility that’s caused by the absence of sperm in your semen (azoospermia). A healthcare provider may recommend microTESE if you wish to have a biological child, but you can’t naturally make or release enough sperm that’s healthy enough to fertilize an egg cell.

How should I prepare for microsurgical testicular sperm extraction?

You’ll meet with a healthcare provider before microTESE. They’ll:

• Review your health history.
• Perform a physical examination to check your general health.
• Take your vitals (temperature, pulse and blood pressure).

Tell your provider about all of your allergies to make your procedure as safe as possible. You should also provide a list of all prescription or over-the-counter (OTC) medications you’re taking, including herbal supplements. Certain medications and herbal supplements may increase your risk of bleeding. Check with your provider before you stop taking any medications.

Your provider will also give you specific directions on eating and drinking before microTESE. You shouldn’t eat or drink anything after midnight the night before your procedure. If you must take medications, you should take them with a small sip of water.

What healthcare providers make up a microTESE team?

In general, the following healthcare providers make up your microTESE care team:

• Urologist.
• Anesthesiologist.
• Nurses.

What happens during microTESE?

A urologist usually performs microTESE in an operating room while you’re under general anesthesia. General anesthesia makes you temporarily fall asleep so you won’t feel pain or be aware of anything else in the operating room during the procedure.

Once you’re asleep, the urologist will:

• Use a surgical knife (scalpel) to make a single cut (incision) in the middle of your scrotum (the pouch of skin behind your penis that usually holds your testicles).
• Make a few tiny incisions in your testicle and remove a small amount of tissue (testicular biopsy).
• Remove a tissue sample from your other testicle, if necessary.
• Send your tissue samples to a lab.

A lab technologist will use a high-powered surgical microscope to look for sperm in the fine tubes of your tissue sample. If the technologist finds sperm, a provider can use it right away to fertilize your partner’s egg or they can freeze it in liquid nitrogen (cryopreservation) and use it later during in vitro fertilization (IVF) treatment.

How long does this microTESE take?

MicroTESE usually takes less than two hours.

What happens after microTESE?

After collecting your tissue samples, a healthcare provider will use dissolvable stitches (sutures) to close your incisions. You’ll also stop receiving anesthesia. You’ll be conscious (awake) after a few minutes but likely feel groggy.

Providers will continue to monitor your health. Once you fully wake up, they’ll treat your pain.

When will I know if sperm is present in my tissue samples?

It depends. The lab may discover healthy sperm immediately after surgery, or it may take a day to get results. Your healthcare provider will let you know what to expect.

What are the benefits of microsurgical testicular sperm extraction?

The main benefit of microTESE is that it increases your chances of having a biological child.

What is the success rate of microsurgical testicular sperm extraction?

Healthcare providers are able to retrieve healthy sperm in up to 60% of microTESE procedures, depending on the cause of azoospermia.

What are the risks or complications of microTESE?

The main complication is that healthcare providers can’t find enough or any healthy sperm in your tissue samples to fertilize an egg.

Possible microTESE risks include:

• Anesthesia risks.
• Bleeding.
• Infection.
• Pain or discomfort.

There’s also a chance of permanent damage to your testicles. But this is very rare.

How long does it take to recover from microTESE?

Most people fully recover from microTESE within a few weeks. You may need to take a few days off work — longer if you have a physically demanding job. You should avoid strenuous exercise and heavy lifting for at least a few days.

The first day or two are often the most painful. Applying an ice pack can help reduce pain and swelling. You can also help relieve pain with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol®). Your healthcare provider may also prescribe prescription pain relievers (analgesics).

When can I have sex after microTESE?

Generally, you should avoid having sexual intercourse or masturbating for at least a few days after microTESE.

Will the microsurgical testicular sperm extraction procedure need to be repeated?

It depends. If your care team uses all of your extracted sperm to fertilize your partner’s egg, you may need microTESE again to achieve another pregnancy. In such cases, it’s usually best to wait six to 12 months between microTESE procedures. You may also choose to bank any remaining sperm.

When should I call a healthcare provider?

Reach out to a healthcare provider if you have any of the following complications after microTESE:

• Severe pain.
• Heavy bleeding around your incision.
• Blood in your pee (hematuria).
• Signs of infection, including fever, chills or discoloration (red, purple, brown or black) or pus around your incision.
• Signs of sepsis.

What is the difference between TESE and microTESE?

Testicular sperm extraction (TESE) is also a method of extracting sperm from testicular tissue. But it doesn’t use a microscope to identify and extract sperm from smaller tubes that may contain sperm.

A healthcare provider may recommend TESE if you have obstructive azoospermia. Obstructive azoospermia means your testicles produce sperm, but there’s a blockage or missing connection in your reproductive tract that prevents sperm from entering your semen.

How much does microTESE cost?

Talk to a healthcare provider. The cost of microTESE may depend on:

• Your health insurance coverage.
• What your provider charges for microTESE.
• Where you get the procedure.

A provider can also refer you to a patient financial coordinator. A patient financial coordinator may be able to help estimate the cost of microTESE.

Does insurance cover microTESE?

Talk to your insurance provider. In many cases, insurance doesn’t cover microTESE. However, some insurance providers may cover microTESE if you have nonobstructive azoospermia or a spinal cord injury that prevents you from ejaculating.

Nonobstructive azoospermia is a type of azoospermia in which your testicles and reproductive tract appear healthy, but hormones don’t stimulate your testicles to release sperm.