Testicular sperm extraction (TESE)
What is it?
Azoospermia, a condition characterized by the absence of spermatozoids in the ejaculate, is found in 5% of couples wishing to become pregnant. Azoospermia can be secretory, that is characterized by the complete absence of spermatozoids caused by a primary pituitary or testicular insufficiency, or obstructive, due to the obstruction of the excretory ducts. Although azoospermia is associated with male infertility, it does not necessarily result in infertility because sperm production can be maintained at various levels within the testis. Therefore, several methods have been developed to recover spermatozoids from the epididymis or testis of infertile men, which can then be used to achieve pregnancy through medically assisted fertilization techniques.
When is this procedure indicated?
TESE is indicated to patients for whom recovery from the epididymis is not possible due to previous attempts or congenital obstruction of the ducts, or patients diagnosed with severe hypospermatogenesis or arrested spermatozoid maturation.
How is it performed?
In these patients with secretory azoospermia, recovery can be attempted with multiple randomly performed testicular biopsies (TESE), or by microsurgical harvesting. In both cases, simple local anesthesia is used. Through an incision at the level of the median raphe of the scrotum, the testis is exteriorized and, after visualizing in optical magnification the testicular blood vessels in the albuginea tonaca, an avascular testicular portion is identified and an incision of the albuginea tonaca is made. With this approach, samples of testicular parenchyma are removed and immediately examined under the microscope to assess the presence of spermatozoids, their motility and quality of progression. In case of unsuccessful research in one testicle, tissue is taken from the contralateral testicle.
Recovery
In the post-operative period, it is necessary to observe a period of rest, and it is useful to apply ice at scrotal level.
Short-term complications
Scrotal pain that may require the use of pain medication. Other possible complications include edema, infection, and scrotal hematoma.
Long-term complications
Hypogonadism, testicular damage, or atrophy can be occasionally observed after TESE surgery.
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