Azoospermia is the condition of an inadequate amount of sperm in ejaculate caused by sexual intercourse or masturbation in men. Azoospermia may be due to obstruction of the genital ducts, poor or incomplete sperm production in the testicles. Even in the absence of sperm in the ejaculate, it can be extracted from the testicles using minimally invasive techniques. After sperm retrieval, it is also possible to create conception using intracytoplasmic sperm injection (ICSI).

The procedure type to be applied for sperm retrieval may vary depending on the cause of azoospermia. MicroTESE/TESA process is also one of the methods used to retrieve sperm

What is MicroTESE?

Non-obstructive azoospermia describes the state of azoospermia that develops without obstruction. This problem is a very common cause of male infertility. If such a problem exists, doctors recommend the MicroTESE procedure, commonly known as microsurgical testicular sperm extraction.

MicroTESE can be performed,

• If the male has sufficient levels of testosterone in his sperm test results,
• If there is azoospermia despite receiving treatment,
• And if there are some chromosomal problems such as Klinefelter syndrome.

The sperm retrieval rate during MicroTESE procedures is approximately 70%. Studies have shown that this procedure gives the highest sperm retrieval rate and causes the least damage to the testicle.

How is MicroTESE performed?

General anesthesia is performed before the operation begins and the person is completely anesthetized. For MicroTESE, very small incisions of 3-4 cm should be made in the midline of the scrotum. Thus, the testicles will be uncovered and the ducts that are possible to contain sperm will be examined under a microscope operating at high power. Tissue samples are collected and the procedure is terminated with the suturing of the testicles.

The scrotum is one of the fastest healing parts of the body. Therefore, the pain sensation after the surgery will be quite low. An ice pack is used for the first 24 hours after surgery and then a number of medications are prescribed to prevent infection. Sexual intercourse, masturbation, and heavy exercises should be avoided for 10 days after the operation.

What happens if sperm is not found in the MicroTESE surgery?

Examination of the samples obtained during the procedure will take approximately 10 to 14 hours. At the end of this period, information is given about whether sperm is found or not. If sperm is found, it is extracted and frozen in liquid nitrogen. The sperm found can be used in the IVF method.

However, if the sperm is not found, it means that the body does not produce sperm. A number of medications may be taken to produce sperm, another treatment plan may be created, and the MicroTESE procedure may be applied again.

What IS TESA?

Testicular sperm aspiration, also known as TESA, is a procedure applied to extract sperm for IVF and microinjection methods. If intrauterine insemination is to be performed, females will also have to undergo routine ovulation induction and egg retrieval at the same time. The sperm isolated during the TESA can then be injected into the eggs retrieved from the female.

TESA may be performed;

• For primary testicular problems with incomplete sperm production,
• For an obstruction in the genital tract,
• For people who underwent vasectomy or unsuccessful reversal vasectomy.

How is TESA performed?

This procedure is performed using local anesthesia or sedation in operating room conditions. A fine needle is placed in the testicles and sperm is aspirated with this needle. In some cases, an open testicular biopsy may be required when TESA cannot provide sufficient tissue or sperm.

What should TESA recipients pay attention to?

It will also be useful to apply an ice compressor after TESA. It is important not to shower until the dressing is removed. Heavy activity and sexual intercourse should be avoided for the period specified by the physician. If there is pain, prescribed painkillers may be used.

If all conditions are met, MicroTESE/TESA procedure can be performed for men who cannot have babies due to infertility. If you need these methods, which are an important step in the treatment of infertility, you should definitely consult your physician.