If you’re trying to conceive, finding out you have an extremely low sperm count, or no sperm at all in your ejaculate, might make you feel pretty hopeless. But it’s not the end of the line for your fertility. Surgical sperm retrieval procedures can be used to find sperm in the testes (testicles) of some infertile men. This sperm can then be used to fertilise your partner’s eggs through assisted reproductive technology (ART).
The preferred technique for sperm retrieval is microdissection testicular sperm extraction (or microTESE). Here’s what you need to know about the microTESE procedure, the recovery process and your chances of conceiving afterwards.
Firstly, what does it mean when you have zero sperm count?
Azoospermia means no sperm are present in the ejaculate.
But when a semen analysis shows that you have no sperm in your ejaculate, it doesn’t mean you have no sperm at all.
What is surgical sperm retrieval (SSR)?
Surgical sperm retrieval is a procedure used to find areas of the testes where sperm are being made, even though they do not show up in your ejaculate.
There are a few different procedures used to retrieve sperm, including percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), and micro testicular sperm extraction (micro-TESE).
PESA and TESA involve using a fine needle to collect sperm directly from the epididymis or testis.
What is microTESE?
MicroTESE is an advanced technique performed by specialised microsurgeons. They use a high-powered microscope to find and remove small sections of the testes where sperm are likely to be found. MicroTESE is the preferred technique for sperm retrieval in men with non-obstructive azoospermia.
What happens during microTESE surgery?
MicroTESE is considered a minor procedure, but it’s still fairly invasive for a sensitive area. So it’s understandable if you’re a little wary about what it involves.
The procedure is done under general anaesthetic, so you won’t feel anything while it’s happening. You’ll most likely be able to go home the same day. Once the anaesthetic has worked, your urologist will make a small cut in your scrotum and make a few tiny cuts in the connective tissue that surrounds the testis to access the sperm-producing tubules inside. Using a microscope, the urologist carefully examines these tubules to find areas that have the highest potential to produce sperm. The surgeon removes these small areas and they are immediately examined by an embryologist, to confirm the presence or absence of viable sperm. If no sperm are found in one testis, the procedure is repeated on the other side.
If sperm are found, they are collected and either frozen and stored or used immediately in assisted reproductive treatments like IVF (in vitro fertilisation) or ICSI (intracytoplasmic sperm injection).
You may know immediately after surgery if sperm were found. Sometimes you will be updated the day after surgery.
What is microTESE recovery like?
After a microTESE you’ll usually go home the same day. Rest is essential for the first few days.
Your doctor may prescribe pain relief and antibiotics.
Most people can return to normal activities within one to two weeks, depending on how they’re healing and after a follow-up with their doctor.
What are the risks of microTESE?
There’s also a chance of permanent damage to your testes, but this is very rare. Your urologist will talk through these risks with you.
What are the success rates of microTESE?
In men with non-obstructive azoospermia the success rate – defined as finding viable sperm suitable for fertility treatment – ranges from 38% to 60% depending on patient factors.
If you’d like more information about microTESE, chat with a doctor who can refer you to a urologist.
