MICRO TESE (m-TESE)

What is micro-TESE?

To perform in vitro fertilization (microinjection) in azoospermic men who have no sperm in their ejaculate, the process of obtaining sperm from the testicles of the patient by surgical methods is called m-TESE.

Is Anesthesia Necessary for m- TESE?

The process continues until sperm is found in the operating room and under the microscope. If no sperm can be found in one testicle, the other testicle should also be examined. Therefore, the whole testicle is carefully evaluated under the operating microscope and samples are taken from the enlarged and plump sperm tubules. The process takes approximately 90-120 minutes (1.5-2 hours). For this reason, general anesthesia is a preferred application.

Is It Necessary to Stay in Hospital after the Procedure?

Surgery is an outpatient surgical procedure. The patient should stay in the hospital only on the day of surgery and until the anesthetic effect wears off. On the same day, the patient is discharged with the recommendations and then called for wound drape in the following days.

Is Sexual Abstinence Necessary before m-TESE?

Normally, if sperm will be searched directly from the testicle and azoospermia is clear, sexual abstinence is not required before the procedure.

Is It Necessary to Take A Sperm Sample before m-TESE?

A small amount of sperm can be found in the ejaculate in some patients. This condition is called "cryptozoospermia" or "virtual azoospermia". If the doctor thinks it necessary, a single or consecutive sperm sample can be taken from the patient before the m-TESE procedure.

Is m-TESE Performed only in Non-Obstructive Azoospermic Male?

According to sperm count and quality, m-TESE can be applied in couples with recurrent reproductive failure, male patients with severe sperm motility problems (total immotile sperm), and cases with insufficient sperm retrieval with TESA before reproductive cycles.

How Many Times Is m-TESE Performed?

There are two main tasks of testicle: sperm production and hormone synthesis. Although m-TESE is performed under the operation microscope, it is a surgical procedure and damages the testicular tissue. The first m-TESE always has the highest success rate. Finding sperm in the first application does not always mean that sperm will be obtained in the following operation. If there is a local focus and this area is taken in the first application, a new focus will not be formed. Therefore, there is no chance of obtaining sperm in m-TESE again. In the male who were sperm was obtained in the first m-TESE, sperm retrieval rate in repeated m-TESE is 80-85%. On the other hand, in cases where the first m-TESE fails, 20-30% sperm can be obtained in a m-TESE made by experienced hands.

Why Is Genetics Necessary?

In azoospermia cases, there is peripheral chromosome abnormality in 5-10% of cases and chromosome-Y deletions in 11-15% of cases. Therefore, genetic tests should be done before m- TESE.

What are the Criteria Showing the Probability of Obtaining Sperm before m-TESE?

Before m-TESE, the patient evaluated carefully with is history and performed detailed physical examination. However, none of these are determinative for sperm retrieval rate. Sperm can be found even in cases of undescended testicle, mumps infections affecting the testicles, and cases undergoing cancer treatments. There is not any relationship between testicular size and sperm retrieval. Additionally, serum hormone levels including FSH, LH, Testosterone, Inhibin B are insufficient to determine sperm recovery.

Why Is the Y-Chromosome Important?

There are three regions involved in sperm production on the Y-chromosome: Azf-A, Azf-B and Azf-C. In these regions, it can be occurred alone or combined partial or complete deficiencies. If there is chromosome Y deletion in following type:

Complete absence in the Azf-A region
Complete absence in the Azf-B region
Complete absence in Azf A + B + C regions (Combined deletion)

there is no chance of obtaining sperm in these cases and m-TESE is not recommended. Therefore, the only determining criterion before m-TESE is Y chromosome evaluation.

What is the Rate of Sperm Obtaining with m-TESE?

While sperm retrieval rate is 30-40% with conventional TESE biopsy procedure, it ranges from 40-60% with m-TESE.

What are the Complications of m-TESE?

In some patients, a temporary hormonal problem that continues for 6-8 weeks after the operation and decreased performance and loss of libido due to testosterone deficiency may occur. In fact, this situation is closely related to the preoperative hormone level of the patient. For that reason, it is important to control the hormone values, especially testosterone levels of the patients before surgery. Rarely, bleeding and hematoma (blood collection), wound infection and testicular atrophy can be observed.

What Should Be Considered after m-TESE?

Antibiotics and painkillers are recommended after the surgery. This treatment should be continued within the recommended time. After the procedure, the patient may be felt pain in the wound and testicle for 1-2 days.

During the post-operative period, it is necessary to avoid compelling movements (such as long walking, heavy lifting). The patient can take shower 2 days after the operation. It is recommended to use special underwear (suspender) for 10-15 days to prevent edema in the testicles after surgery. If he is using anti-coagulant drugs, they are appropriate to stop these drugs one week before the surgery and not to use them until one week after.