MICRO-TESE: Advanced Sperm Retrieval
Micro-TESE (Microsurgical Testicular Sperm Extraction) is an advanced surgical technique used to retrieve sperm directly from the testicular tissue, especially in men with non-obstructive azoospermia (NOA) — a condition where no sperm is found in the ejaculate due to poor or absent sperm production.
It is often used in combination with ICSI (Intracytoplasmic Sperm Injection) in couples with previous IVF/ICSI failures due to male factor infertility.
What Is Micro-TESE?
- Microsurgical technique performed under an operating microscope to identify seminiferous tubules likely to contain sperm.
- Minimally invasive and precise—less damaging than conventional methods.
- Offers higher sperm retrieval rates in men with limited sperm production.
When Is Micro-TESE Recommended?
- Non-obstructive azoospermia (e.g., Sertoli-cell-only syndrome, maturation arrest, hypospermatogenesis)
- Previous failed sperm retrieval attempts (TESA or TESE)
- Men with genetic conditions such as Klinefelter Syndrome
- Men with focal sperm production despite testicular failure
Why Combine Micro-TESE with ICSI?
The sperm retrieved using Micro-TESE are often few in number and immotile, making natural fertilization unlikely. ICSI allows the embryologist to inject a single viable sperm directly into each mature egg.
- Useful after repeated IVF/ICSI failures due to male infertility.
- Enables fertilization when ejaculate contains no sperm, but testicular tissue does.
Considerations and Preparation
- Performed under local or general anesthesia
- Testicular biopsy sent for histopathology
- Retrieved sperm may be cryopreserved
- Requires an experienced male infertility surgeon
TESTICULAR MAPPING (FNA Mapping)
Testicular Mapping (or FNA Mapping) is a diagnostic procedure used in men with non-obstructive azoospermia (NOA) to identify areas of sperm production before attempting retrieval procedures like Micro-TESE. It helps plan and improve the success rate of sperm retrieval while minimizing unnecessary tissue damage.
What Is Testicular Mapping?
- Minimally invasive outpatient procedure using fine needles to extract small samples from various testicular regions
- Samples are analyzed microscopically for sperm presence
- Typically done under local anesthesia
Purpose of Testicular Mapping
- Locate active "hot spots" of sperm production
- Avoid unnecessary surgeries in men with low success chances
- Guide Micro-TESE or other retrieval methods
- Improve ICSI outcomes by targeting the right areas
Who Needs Testicular Mapping?
- Men with non-obstructive azoospermia (NOA)
- Those with prior failed TESA or Micro-TESE
- Men with testicular failure (due to genetic, chemotherapy, or unknown reasons)
- Couples facing IVF failure due to male factors
How the Procedure Works
- Local anesthetic numbs the testicles
- Fine needle aspirates cells from mapped points on both sides
- Samples are microscopically examined for sperm
- A detailed "sperm map" is created to plan the next step
Benefits of Testicular Mapping
| Benefit | Description |
|---|---|
| Precision | Identifies sperm-producing zones for accurate targeting |
| Minimally Invasive | Reduces need for full-scale surgery |
| Cost-Effective | Helps avoid unnecessary surgical interventions |
| Pre-IVF Planning | Improves chance of ICSI success if sperm is located |