Overview
Testicular sperm extraction (TESE) is a procedure that is performed to obtain sperm directly from the testicle in men with a condition referred to as obstructive azoospermia, or a few specific circumstances. Men with obstructive azoospermia produce sperm at normal rates, however they have a blockage that is preventing sperm from traveling from the testicle to the penis. Reasons that this procedure may be performed include a history of vasectomy, a history of infection or injury to the vas deferens (the tube that carries sperm from the testicle to the penis), a congenital absence of the vas deferens, extremely low sperm counts, and an elevated DNA fragmentation index. Any sperm that is retrieved using this procedure will need to be used for in-vitro fertilization. The concentration of sperm that we are able to get with this procedure is not enough for intrauterine insemination.
This procedure is not recommended in men with a condition refer to as non-obstructive azoospermia. Men with non-obstructive azoospermia have no sperm visible on semen analysis due to either no or extremely low sperm production in the testicle itself. For men with non-obstructive azoospermia, it is recommended that they undergo a specialized type of testicular sperm extraction procedure called microsurgical testicular sperm extraction (MicroTESE).
Types
Testicular Sperm Extraction (TESE)
TESE is a 30-minute minimally invasive procedure that can be performed in the office or in the operating room under general anesthesia (completely asleep). The vast majority of patients choose to have it done in the office due to cost and convenience. If performed in the office, you will have the option of medication that will help relax you as well as a local anesthetic to numb your testicle and the skin around it. We will then make a small opening in the skin to remove a small amount of tissue from the testicle. This tissue will then be looked at under the microscope to make sure that there is adequate sperm in the sample. The tissue will then be sent to the lab to be frozen and stored (called cryopreservation) until future use with in-vitro fertilization. Typically the amount of sperm that we are able to get during this procedure is enough for multiple cycles of in-vitro fertilization. The skin is then closed with the dissolvable suture, and it will likely heal with minimal scarring.
Microsurgical Testicular Sperm Extraction (MicroTESE)
MicroTESE is a more invasive procedure that can also be performed in the office or in the operating room under general anesthesia (completely asleep). This procedure takes approximately 3-4 hours. If you choose to have it done in the office, we will provide you with a medication that will relax you and may cause you to fall asleep, however you will not be completely asleep for the entire procedure. We also used a long-acting anesthetic to numb your testicle and the skin around it. Similar to a TESE, we will make an opening in the skin, however, we will make a much larger opening in the testicle compared to TESE so that we can sample different areas to find an area where there may be normal sperm production. To look for areas where there may be sperm production, we will use a high-powered operating microscope which provides up to 40 times magnification.
We then sample tissue from different areas of the inside of the testicle. As we sample tissue, we will look at that tissue using a standard microscope to see if there is any sperm present. We will continue this sampling process until we are able to find sperm. If we are unable to find any sperm on one side, we will repeat the procedure on the other testicle. When we are done we will close the opening in the testicle using fine suture, and closed the skin using a dissolvable suture. The tissue that we collected is then given to an Andrology technologist who will continue to examine it under a standard microscope to see if there is any sperm, and if there are sperm present will freeze and store it for future use. We will contact you the day after your procedure to let you know if we found any sperm. It can take several hours of searching under the microscope to determine if any sperm are present.
If no sperm are found during this procedure or if you choose not to undergo micro testicular sperm extraction, the other alternatives are sperm donation or adoption.
Recovery
Regardless of which procedure you have done, you will be given the same set of instructions after the procedure.
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All skin sutures are dissolvable, so you will not need to return to have them removed
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Remove dressing in 24 hours and resume showering
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Most men can return to work within 24 hours
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No heavy lifting greater than 10 pounds or strenuous physical activity for 2 weeks
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Ok to resume intercourse in 1 week
Complications and Risks
Risks and complications associated with TESE or microTESE are rare, occurring less than 5% of the time, but may include:
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Bleeding
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Skin or testicle infections
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Inability to find sperm
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Transmission of a potential genetic cause of infertility to any offspring resulting from use of the sperm
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Decrease in size of the testicle
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Chronic pain of the testicle
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Disruption to blood flow of the testicle
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Risks of general anesthesia if you choose to have it performed in the operating room
What to Expect From your Visit
POST-OPERATIVE INSTRUCTIONS FOR TESTICULAR SPERM EXTRACTION (TESE):
GENERAL:
If you experience any fevers > 100.4, significant nausea, vomiting, significant worsening of pain or progressive enlargement of the scrotum, please contact the number below. Limit activities which may put pressure or cause trauma to the scrotum for 2 weeks. There are no specific lifting restrictions.
WOUND CARE:
Keep sterile dressing in place for 24 hours after the surgery and continue to wear tight undergarments for 1 week after surgery. You may resume showering once dressing is removed. You may submerge the wound in water (bathing, hot tubs) beginning 1 week after surgery.
PAIN MANAGEMENT:
In general, use acetaminophen (Tylenol Extra Strength) one to two tabs every six hours for pain. In pain is unrelieved, narcotic pain medication may be used. To speed up the recovery process, the use of narcotics should be minimized.
It is best to take pain medications before pain becomes severe. This will allow you to take less medication yet have better pain relief. For the first 2 to 3 days it may be helpful to take pain medications on a regular schedule (e.g. every 4 to 6 hours). This will help you to keep your pain under better control. You should then begin to take fewer medications each day until you no longer need them. Do not consume more than 3000 mg or 3 gm of Tylenol or acetaminophen-containing products within a 24 hour time period to avoid damage to your liver.
FOLLOW-UP:
A post-procedural follow up appointment is not necessary, but if you wish to schedule an appointment with the Urology provider who performed your TESE, please call the Urology Appointment Office (507) 266-3430. If you are recovering well without any concerns, this appointment is not required.
If you have any questions relating to your surgery you can contact your surgeon in the following ways:
Call the Men’s Health secretary (507) 266-3982 and she will send a message for you. Someone from the team will return your call during regular business hours.
To contact the Men’s Health nurses, call the Urology Appointment Office (507) 266-3430. A message will be sent to them and one of them will return your call.
After hours or with emergency concerns please call (507) 284-2511 and ask to speak with the resident on call for the provider you saw (Dr. Helo, Dr. Kohler, or Dr. Ziegelmann)
If you have the patient portal please feel free to send a message about non-emergent concerns via online messaging. Your message will be responded to by a member of Dr. Helo’s, Dr. Kohler’s, or Dr. Ziegelmann’s team, including a RN, Steve Carlson, CNP, Elise Tentis, PA-C, Kate Nelson, PA-C, or the resident working with Dr. Helo, Dr. Kohler, or Dr. Ziegelmann.