Microdissection Testicular Sperm Extraction (Micro-TESE)
For men who do not have sperm in the ejaculate fluid, one option may be to go directly to the testicle and look for any small areas of sperm production. This is called microdissection testicular sperm extraction, or “micro-TESE”. The testicle is opened, and systematically inspected under the operative microscope, to locate any small areas where sperm are being produced within the testicle. Multiple areas are sampled and immediately examined to see if sperm are present. Any sperm that are found can only be used for In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI).
The procedure takes 1-4 hours, depending on the size of the testicles and how long we have to look to find areas of sperm production. A general anesthetic is required. Some men are placed on hormonal medication for 3 months in advance of this procedure in order to optimize surgical sperm retrieval rates.
Since we cannot guarantee that sperm will be found during the micro-TESE procedure, we oftentimes have a “back-up plan”. Many couples opt to have donor sperm as a back-up, which have been selected in advance, and may be used for fertilization if sperm are not found at the time of the micro-TESE procedure.