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Microsurgical Testicular Sperm Extraction (microTESE)

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What Is microTESE?

MicroTESE, or microsurgical testicular sperm extraction, is one of the best treatments for male infertility caused by nonobstructive azoospermia.

Doctors who do microTESE use a special high-magnification microscope to look all around the seminiferous tubules and find any pockets of sperm. They then remove a few tiny tissue samples for testing.

Compared to other treatments, microTESE lets doctors find more sperm in smaller amounts of tissue.

Doctors often suggest it when other treatments haven't worked.

Conditions We Treat with microTESE

At UPMC, we treat male infertility caused by nonobstructive azoospermia.

This condition means that a male makes or releases low numbers of sperm in the semen, sometimes releasing none.

About one in 10 men who see a male infertility specialist have the condition.

Causes of nonobstructive azoospermia can include:

  • Certain drugs.
  • Enlarged veins in the scrotum.
  • Hormone or genetic issues.
  • Radiation treatments.

But even men who have no sperm in their semen may have sperm in the seminiferous tubules of their testes.

Learn More About Male Infertility

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How to Prepare for microTESE

Take these steps to get ready for your treatment:

  • Don't eat or drink anything after midnight the day before.
  • Follow your doctor's exact instructions on dietary supplements and medications.
  • Wear comfortable clothes, such as sweatpants.
  • Arrange a ride home for after your microTESE.

What to Expect Before, During, and After microTESE

Your care team will help you know exactly what to expect before, during, and after treatment.

Before microTESE

Before having microTESE to treat male infertility, you'll likely need tests such as:

What happens during microTESE

UPMC urologists trained in microsurgery perform microTESE under general anesthesia. That means you'll be asleep during the procedure.

Microsurgery is any surgery that uses an operating microscope. It gives doctors access to small vessels and tubes in the body without damaging them.

During microTESE, your doctor will:

  • Make a small cut — about one inch long — in your scrotum.
  • Use the microscope to look at the seminiferous tubules through the cut.
  • Check for any pockets that seem to contain sperm and then remove a small tissue sample.
  • An embryologist, a specialist who finds sperm under a microscope, will study the sample.

If they find any sperm that might function in reproduction, they'll freeze them right away to preserve them for future fertility treatments.

If there are no sperm in samples from the first testis, your doctor will repeat microTESE and look in the second testis.

The length of the procedure depends on how fast your doctor finds sperm.

At the end of the exam, your doctor will close the incision with stitches. The stitches will dissolve in about a week.

Healing after microTESE

You'll be able to go home the same day.

You might want to wear a jockstrap while you're healing.

To relieve any pain or discomfort, you'll need to ice your scrotum for the first 24 hours. Your doctor may also prescribe pain relievers and antibiotics.

You can get back to your job after a day or two. But wait a week to 10 days before having sex or masturbating.

You'll also need to wait 10 days before working out or doing other physical activity, like lifting heavy objects.

Call your doctor right away if:

  • You're still under a lot of pain after a few days.
  • Your scrotum gets hot, red, or swollen.
  • You see blood at the incision site.

Risks and Complications of Microsurgical Testicular Sperm Extraction

MicroTESE is a relatively low-risk surgery to treat male infertility.

Possible risks or problems include:

  • Bleeding, infection, or bruising at the incision site.
  • Pain at the incision site or in the testes.
  • Damage to the testicle (very low risk).

As with all surgeries under anesthesia, there's also a very small risk of a reaction to the anesthetic.

Microsurgical Testicular Sperm Extraction Outcomes

MicroTESE lets doctors fully see inside the testicles. That makes it one of the most successful ways to find healthy sperm and treat male infertility.

Sometimes doctors can't find any sperm. Other times, they might not be able to remove the sperm they do find. If that happens, you might need to have a repeat microTESE.

It's best to wait at least six months before having a repeat procedure.