TESE Procedure: Steps, Success Rate, Recovery & Male Infertility Use

What Is TESE?

Testicular Sperm Extraction (TESE) is a quick procedure that involves a small surgical incision to remove sperm from the testicles. This is recommended in cases where sperm are produced in the testes, but these sperm are absent in the semen due to various issues. The condition referred to is non-obstructive azoospermia. After making a tiny incision, sperm are extracted directly from the testes using Micro TESE. The sperm obtained is later used for fertilisation, most probably by Intracytoplasmic Sperm Injection (ICSI).

It is recommended for men who produce sperm within the testicles but have a blockage or very low sperm production that prevents it from appearing in the ejaculate. There is minimal possibility of ending testicular tissue because the therapy is administered using a precision microsurgical approach.

Types of TESE

• Conventional TESE: It is the normal TESE, in which testicular tissue is randomly sampled to extract sperm.
• Microdissection TESE (Micro-TESE): Micro-TESE involves the use of an operating microscope to locate areas in the testicle that have a higher chance of having spermatozoa. Whereas it is more invasive and usually done under general anaesthesia, micro-TESE has a higher success rate in the extraction of sperm.

How TESE Helps in Male Infertility

Male infertility may result from a variety of factors, such as a blockage or absence of sperm ducts, low sperm production, hormonal imbalance, and testicular damage. TESE works by locating and picking up the sperm directly from where it is produced.

Benefits of TESE in male infertility include:

• It makes possible the retrieval of sperm even in cases of extreme azoospermia.
• Moreover, the use of advanced reproductive methods, such as ICSI, is made possible.
• Hope is given to those cases in which the ejaculation is entirely devoid of sperm.
• It assists in diagnosing sperm production in the testicles.
• It opens the doors to the development of personalised fertility treatment plans.

Step-by-Step TESE Procedure

The TESE process is designed to be simple, safe, and minimally invasive.

Step 1: Consultation and Evaluation

Fertility specialists will review the medical history, hormonal tests, past surgeries, testicular examination and semen analysis. Imaging tests can be performed if necessary.

Step 2: Anaesthesia Administration

It is performed under local or general anaesthesia, depending on the patient's comfort and the type of TESE to be performed.

Step 3: Surgical Access

A testicle is accessed by making a small incision in the scrotal skin. In micro-TESE, a surgeon will be guided to the healthiest parts using a microscope.

Step 4: Tissue Extraction

A small piece of testicular tissue is taken. The sample is then subjected to laboratory analysis.

Step 5: Sperm Identification

Embryologists process the tissue, and motile, healthy sperm are sought under the microscope.

Step 6: Preservation and Use

If sperm is found, it is either:

• used immediately for ICSI, or
• frozen for future use

Step 7: Closure and Dressing

The small incision is sewn with dissolvable stitches, and a dressing is applied.

Step 8: Discharge

The patient might return home the same day after a very short observation time.

Risks and Complications

TESE is considered a low-risk procedure. Nevertheless, this kind of surgery might bring along:

• Mild pain or discomfort
• Swelling of the scrotum
• Bruising
• Temporary infection (rare)
• Slight bleeding
• Risk of decreased testosterone production in rare cases

Generally, these risks can be controlled if the patient receives the correct medical attention.

Recovery After TESE

Once the process is complete, the patient is monitored in the recovery room, where he is monitored by medical personnel until the anaesthetic effect wears off. When the patient is stable, he is sent home or transferred back to a hospital room if he was admitted for other reasons.

At home, mild pain, swelling, or tenderness of the scrotum should be anticipated in the course of a few days. Doctors can offer advice on how to cope with pain and avoid infection. Key points include:

• Taking all prescribed medicines exactly as advised.
• Mild bruising or swelling of the scrotum is expected and usually resolves within a week.
• Using pain-relief measures as recommended
• Following guidance for bowel regularity, especially if discomfort medicines cause constipation
• Reaching out to a doctor if regular bowel movements have not resumed after 3 days.

These symptoms are mostly short-lived and improve over time during the recovery process.

Success Rate of TESE

An underlying condition and the nature of the technique determine the success of TESE. Micro-TESE has a higher sperm retrieval rate than traditional TESE, as it relies on magnification to identify regions of higher sperm production.

Factors influencing success include:

• Cause of azoospermia
• Hormone levels
• Testicular size and health
• Previous surgeries or infections
• Age and reproductive health in general.

The majority of clinical trials note that micro-TESE offers much better retrieval of sperm in men with non-obstructive azoospermia, but the results depend on the patient-to-patient.

Conclusion

TESE is a significant breakthrough in the treatment of male infertility, which provides a means of accessing sperm despite the absence of sperm in semen. By careful consideration, good surgical practice and appropriate laboratory assistance, it does go a long way in increasing the likelihood of a successful fertilisation process with assisted reproductive technology. The process is usually safe, recovery can be maintained easily, and results continue to improve with current medical practice. For many couples, TESE provides renewed hope on their path to parenthood.