John J. Bauer, M.D.
TESE (Testicular Sperm Extraction)
or TSA (Testicular Sperm Aspiration)
John J. Bauer, MD, Urologist
TESE (testicular sperm extraction) or TSA (Testicular Sperm Aspiration) refers to a surgical procedure designed to extract sperm directly from the testis for use in an IVF cycle. TESE is most often performed in individuals with no sperm in their ejaculate due to poor sperm production. In some cases, TESE is performed in individuals with a blockage in the epididymis or vas deferens. The likelihood of success with TESE depends on the histology of the testis. That is, if the patient has had a testis biopsy before, the findings can predict the likelihood of successful sperm retrieval with TESE. In general, if a diagnostic biopsy showed any normal spermatogenesis, the likelihood of successful TESE is approximately 90 percent. If the biopsy showed maturation arrest, that is, no matures sperm but many immature forms, the likelihood of success is approximately 50 percent. If the biopsy showed no sperm at all, so called germ cell aplasia or Sertoli cell only, the likelihood of finding sperm with TESE is approximately 20 percent. Because biopsy results can help a couple to make a decision regarding IVF, it is generally recommended that a biopsy be performed prior to an IVF cycle in cases of severe male factor infertility. The diagnostic biopsy specimens can be cryopreserved for future use if necessary.
TESE takes between 1 and 2 hours to perform. It is performed under local, regional or general anesthesia with the assistance of an operating microscope. The patient can return to deskwork as early as 2 days after surgery, however, strenuous physical activity (jogging, weight lifting, sex) is limited for one month. Sperm retrieved from a TESE procedure are used in a procedure called ICSI or intracytoplasmic sperm injection. In this procedure, eggs from the female partner are retrieved on the morning of the TESE procedure. The sperm retrieved in TESE are then injected directly into the mature eggs within approximately six hours of retrieval.
Follow-up after TESE includes an office visit at one month to check the incisions, hormone studies at three and six months, and a scrotal sonogram at six months to check that the testicles have healed.