What is TESE?

TESE (Testicular Sperm Extraction) is a surgical sperm retrieval procedure in which a small amount of testicular tissue is removed and examined to look for sperm. It may be used in selected men with azoospermia or severe male infertility when sperm cannot be obtained through ejaculation. If viable sperm are found, they may be used with assisted reproductive treatment such as ICSI.

Testicular Sperm Extraction (TESE) is a procedure used to retrieve sperm directly from the testicular tissue.

It may be considered when sperm are absent from the semen or cannot be obtained through normal ejaculation. The appropriate sperm retrieval technique depends on the underlying cause of infertility.

How is TESE performed?

TESE is generally performed under local or general anesthesia, depending on the clinical situation.

During the procedure:

1. A small incision is made to access the testicle.
2. A small sample of testicular tissue is removed.
3. The tissue is sent to the laboratory.
4. An embryologist examines the tissue for viable sperm.
5. If sperm are identified, they may be prepared for use in assisted reproductive treatment.

The exact technique and anesthesia plan depend on the patient's condition and the treating specialist.

Who may need TESE?

TESE may be considered for selected men with:

• Azoospermia.
• Severe impairment of sperm production.
• Situations where sperm cannot be obtained through ejaculation.
• Certain cases where sperm retrieval is required for IVF/ICSI.

However, TESE is not necessary for every man with azoospermia. The underlying cause should be evaluated first.

TESE for obstructive vs non-obstructive azoospermia

The treatment approach can differ depending on the type of azoospermia.

Obstructive azoospermia:
The testicles may continue producing sperm, but a blockage prevents sperm from reaching the semen. Sperm retrieval may be one option, although reconstructive treatment may also be considered in selected cases.

Non-obstructive azoospermia:
Sperm production is significantly impaired. In selected men, Micro-TESE may be preferred because it allows a microsurgical search for areas of the testicle that may contain sperm.

What happens if sperm are found?

Retrieved sperm may be used for ICSI (Intracytoplasmic Sperm Injection) as part of assisted reproductive treatment.

The fertility team coordinates sperm retrieval and laboratory procedures according to the couple's treatment plan.

Is TESE the same as Micro-TESE?

No. Both procedures are used to retrieve sperm from the testicle, but the technique is different.

• TESE: Testicular tissue is removed and examined for sperm.
• Micro-TESE: An operating microscope is used to identify areas of the testicle that may contain sperm-producing tissue before tissue is carefully removed.

For selected men with non-obstructive azoospermia, Micro-TESE is generally the preferred surgical sperm-retrieval approach.

Are there risks associated with TESE?

As with any surgical procedure, TESE may involve risks such as:

• Pain or discomfort.
• Swelling or bruising.
• Bleeding.
• Infection.
• Temporary changes in testicular function.
• Failure to retrieve viable sperm.

Your specialist will explain the potential benefits and risks before recommending the procedure.

SCI International Hospital

At SCI International Hospital, New Delhi, Dr. Vishal Dutt Gour, Senior Consultant Urologist and Andrologist, evaluates men with azoospermia and severe male infertility to determine the most appropriate sperm retrieval approach. Depending on the underlying cause and testicular sperm production, he may consider TESE, TESA, or Micro-TESE and coordinate the retrieved sperm with assisted reproductive treatment when required.