Testicular sperm extraction is a surgical procedure for collecting small specimens of testicular tissue and extracting viable sperm cells. Like other microsurgical procedures, such as micro-epididymal sperm aspiration (MESA) and percutaneous epididymal sperm aspiration (PESA), this procedure is done in an outpatient setting. However, there are some differences. Instead of undergoing general anesthesia, the donor is placed under local anesthesia with sedation. Also, in TESE, the sperm cells are harvested from the testes themselves, not the epididymis.
Men who have been diagnosed with azoospermia, caused by the absence of the vas deferens, or due to prior vasectomy, are good candidates for testicular sperm extraction. Additionally, men who are suspected of having non-obstructive azoospermia (i.e. a malfunction within the testes may be at fault) may benefit from TESE, since both MESA and PESA would not be successful at harvesting viable sperm.
After semen analysis and sperm morphology have been performed, and the patient has been advised and referred for testicular sperm extraction, the surgery is scheduled. Since TESE is a procedure that must coincide with intracytoplasmic semen injection, it must be done at the same time the female partner is undergoing ovulation.
At the start of the procedure, the patient is prepped, and the anesthesiologist administers the patient a local anesthetic and a sedative. TESE is an open surgical procedure, which is performed under direct vision. This allows for fewer complications to occur. An incision about 10 mm in length is made in the skin, allowing a small slice of testicular tissue to be removed. The patient would recover within hours, and can be sent home to return to normal activity within the same day.
Although most men may be understandably intimidated by the idea of testicular biopsy, TESE is a simple, relatively low-cost, and virtually pain-free operation.