TESE And MicroTESE Specialist

What is testicular sperm extraction (TESE)?

Testicular sperm extraction (TESE), also known as sperm harvesting, is a surgical procedure that involves Dr. Zeitlin retrieving sperm from the testis or epididymis. The type of TESE you’ll most benefit from depends on the type of problems you’re experiencing. For example, if you have a blockage you might benefit from a simple aspiration procedure. However, if you have a sperm production problem or low testosterone, more extensive testing may be necessary. 

What types of TESE do you offer?

At Los Angeles Infertility and Prostatitis, Dr. Zeitlin offers an array of sperm harvesting options, including:

TESE

During a TESE procedure, Dr. Zeitlin makes a small incision in the testis and examines your tubules for the presence of sperm. Whenever possible, Dr. Zeitlin schedules TESE in coordination with your partner’s egg retrieval. He can perform the procedure under general anesthesia or in-office with local anesthesia. After treatment, you have the option to freeze your sperm for future in vitro fertilization treatments (IVF).

MicroTESE

Microdissection TESE, or MicroTESE, is a procedure recommended for men who have a sperm production problem, such as azoospermia. You might also benefit from MicroTESE if you have low testosterone. Dr. Zeitlin performs MicroTESE under general anesthesia using an operating microscope. He coordinates MicroTESE with your partner’s egg retrieval and typically schedules the procedure a day prior. This allows for reach partner to be present during the other’s operation. Compared to traditional TESE treatment, MicroTESE requires the removal of less testicular tissue and provides better overall results.

What type of sperm retrieval is right for me?

The type of sperm harvesting treatment you’ll most benefit from depends on the underlying cause of your fertility problems. If you produce normal amounts of sperm but have a blockage, a simple procedure such as aspiration may be enough to start a family. However, if you have low testosterone or another more complex problem, Dr. Zeitlin typically recommends MicroTESE. MicroTESE increases the chances of finding viable sperm and also ensures a quicker recovery time. 

Following an exam and review of your medical history, Dr. Zeitlin develops a treatment plan that aligns with your individual needs. 

If you and your partner are struggling to conceive, sperm harvesting techniques such as TESE and MicroTESE are worth considering. Don’t let male infertility problems prevent you from starting the family of your dreams. To make your appointment, call the office nearest you today.

Fresh vs Frozen microTESE

The question of whether to do a fresh or a frozen mTESE comes up often. Male fertility experts routinely prefer to do their surgeries electively as they are much easier to schedule. A sperm retrieval coupled with an IVF cycle makes scheduling difficult as we are slaves to way the female patient responds to medication and thus when the egg retrieval will be. Sometimes if the female does not respond to stimulation the cycles are cancelled. We do mTESE procedures either electively (frozen) or fresh. When we do fresh mTESE procedures they can be either the day of the egg retrieval or 1 or 2 days prior. To be clear even if the procedure is a few days prior, the sperm does not need to be frozen. We published a study looking at testis sperm motility and it peaks at 96 hours. Another study looked at outcomes with frozen vs fresh testis sperm obtained at the time of mTESE. The frozen sperm did better. This study was biased because only the strongest sperm are able to survive being frozen and then thawed and still remain viable. That said, while the scheduling is more difficult and possibly more costly (most surgery centers are not open on the weekend and the ones that are charge more for weekend surgery, meaning the OR and anesthesia) I believe a fresh mTESE in concert with an IVF cycle and egg retrieval is better. This option is more expensive because it involves the IVF cycle. Considering in most cases the mTESE is only 50% successful at finding sperm then you will need to have a donor sperm backup if this is something you are willing to consider. I think this is the best option by far should we fail to find sperm in the OR. Obviously, all the decisions involving IVF are best made with your partner.

Some things to keep in mind regarding mTESE include the inability to freeze very low numbers of sperm, the possibility that my embryologist sees sperm in the OR, but your IVF center does not (or vice versa), whether to include testicular stimulation with medicines like clomiphene citrate (Clomid) or hCG (Novarel) and whether to perform a mTESE on the other side if we do or don’t find sperm on the first side. There is about a 10% chance of finding sperm on the 2nd side if we do not find it on the first. And if we believe we have sperm to freeze from one side, do we go to the other. All of these questions should be answered before you undergo mTESE. Keep in mind I am doing the surgery while the embryologist looks for sperm. I rely on the embryologist not only to let me know if sperm is found, but whether we have enough to freeze. It is also important to note that even if we believe we have enough sperm to freeze it may not survive the freeze/thaw process.

Just to make it even more complicated finding sperm is just the first step. The sperm we find will need to fertilize the eggs. If this is successful then the embryo will need to grow to become a blastocyst. Even if it grows to be a blastocyst it may not be euploid (having the correct # of chromosome) and if it is not euploid, it is not viable. Even if the embryo is euploid it may not implant and if it does it may not result in a live birth. So many things need to happen along the way to have to a baby. These are all things to keep in mind. Should you have further questions please let us know.