Testicular Sperm Extraction

While men with low sperm concentrations can often succeed with IVF through ICSI, others may experience an absence of sperm in the ejaculate, yet they may still have sperm in their testicles. That's when Testicular Sperm Extraction (TESE) can make a difference in the outcome of fertilization.

TESE is a surgical sperm retrieval procedure performed by experienced urologists in conjunction with laboratory experts. It involves the removal of a small amount of testicular tissue or epididymal fluid (under a local anesthesia or light sedation), which is then immediately transported to the IVF laboratory for processing. An embryologist then extracts the sperm from the biopsy specimen to utilize for ICSI and IVF.

Men lacking sperm in their ejaculate are often categorized with one of the following:

  • Obstructive Azoospermia: This indicates that a blockage exists in the ducts that are supposed to transport sperm from the testicle. This condition may be congenital or acquired, such as an effect of a vasectomy. Hence sperm production is normal, but the flow is blocked. Extraction may occur via a needle in the testicle (testicle sperm aspiration or TESA) or through TESE, taking a biopsy of the interior of the testicle.
  • Non-obstructive Azoospermia: Sperm count is dramatically low in these cases, which is causing the lack of it in the ejaculate. However, numerous men still have areas of the testicles that continue to produce sperm, which may be tapped via TESE. A more recent technique is the micro-TESE, which identifies the productive areas of the testicle through a microscope, so a targeted biopsy may be taken. Similarly, testicular mapping involves tiny needle biopsies and an examination of the fluid to pinpoint areas with the highest sperm concentration.

These groundbreaking advances have dramatically reduced the need for donor sperm and vasectomy reversals, as tapping the reservoir in the testicle has become highly effective over the past few years. Extracted sperm is typically cryopreserved for any subsequent IVF and ICSI procedures.