Azoospermia, which is one of causes of male infertility, diagnosed when there is no sperm in semen. The last resort for azoospermia, an advanced infertility problem, is surgical methods. Azoospermia can be divided into obstructive and non-obstructive.
The most successful surgical method for non-obstructive azoospermia is micro-TESE (Testicular Sperm Extraction) surgery. Micro-TESE surgery is defined as collecting testicle tissue from men with azoospermia and obtaining sperm. Micro-TESE surgery is a high-tech reproductive technique that helps collect sperm from 40–60% of men with azoospermia.
What is Micro-TESE Surgery?
Micro-TESE, which is accepted as the most effective method for azoospermia treatment, is a type of microdissection method. It is also known as infertility or azoospermia surgery. Micro-TESE can be explained as collecting sperm from testicles with a biopsy. Micro-TESE surgery is among the last resorts for male infertility treatment and involves collecting main sperm cells inside the testicle tissue. The tissues are collected from 4 locations from each testicle, and live sperm cells are selected after certain processes.
These cells, which do not have mobility capability due to certain problems, are frozen. The collected sperm is injected into an ovary cell with the microinjection (ICSI) method and used for in vitro fertilization treatment. The success rate increases as the sperm tubes in micro-TESE surgery are viewed with a microscope.
How is Azoospermia Surgery Performed?
In obstructive azoospermia cases, the obstruction can be eliminated with surgical operations to increase the chance of pregnancy. The most preferred method for non-obstructive azoospermia cases is micro-TESE surgery.
Micro-TESE surgery is mainly performed under general anaesthesia. The azoospermia operation is performed by opening small incisions around the genital region. Under a microscope, the sperm tubes are enlarged 25–30 times, and the fuller tubules are identified. Sperm is then sought in tissues collected from both testicles with the biopsy method. The sperm undergo a series of processes to be frozen and prepared for in vitro fertilization treatment.
Micro-TESE surgery takes approximately 2 hours. The patients are discharged a short time after the surgery, and they can recover at home. The experience of the team and equipment quality play an important role in azoospermia surgery performed with special hardware.
Who can Have Micro-TESE?
Azoospermia, defined as having no sperm cells in semen, might occur for various reasons. Azoospermia does not show any symptoms in most cases, and a spermiogram is necessary for diagnosis. Men with zero sperm after spermiograms are investigated in detail to identify the root reason. The treatment plan is prepared after the cause of azoospermia is identified. While medication treatment is used for patients with hormonal disorders, surgical operations are recommended for obstructed tubes. An infertility surgery known as micro-TESE is recommended for non-obstructive azoospermia patients.
These patients might experience repeatedly unsuccessful in vitro fertilization interventions, although there is sperm in the semen. One of the most common reasons for this is DNA damage to the sperm. Sperm is produced in the testicles and discarded with semen after approximately 90 days. During this journey, there might be certain problems in the genetic materials of sperm. Therefore, micro-TESE is recommended for patients with repeatedly unsuccessful in vitro fertilization to use higher quality sperm, even if there is sperm in the semen.
Who Cannot Have This Surgery?
The Y-chromosome that determines the male sex has an AZF section to control sperm production, and this region has 3 separate sections called a, b and c. Any anomalies in these sections cause sperm production problems to varying degrees. Sperm production is impossible with a, b or all 3 sections of the AZF section missing. Therefore, these patients cannot undergo a micro-TESE procedure. Otherwise, all non-obstructive azoospermia patients are suitable candidates for micro-TESE surgery. This infertility surgery, with a high success rate, is the last resort for men who want to have children. There is no other alternative for patients who cannot achieve results with micro-TESE.
What Should Patients Consider Before Micro-TESE Surgery?
Micro-TESE, which is an azoospermia surgery, is performed in the operating theatres of in vitro fertilization centres licenced by the Ministry of Health. The time for this procedure performed for male infertility treatment is determined by an andrologist/urologist planning the treatment process. The readiness of the women is also important, and the operation is done on ovary collection day. There is no need to follow a special diet before micro-TESE surgery.
Sexual abstinence might be recommended for patients with a low sperm count. However, there is no need to follow a specific diet for full-azoospermia cases. The most important thing to consider before infertility surgery is to stop using anticoagulants 1 week before the operation if the patient is using anticoagulants. Patients with chronic systemic diseases such as diabetes and hypertension should be able to manage these diseases. Additionally,
- The hair on the genitals must be cleaned.
- Patients must avoid solid or liquid food 6 hours before the operation.
- Patients must bring baggy pants or leggings to wear after the operation.
Does Micro-TESE Surgery Have any Risks?
Micro-TESE surgery does not cause any major risks other than standard surgical risks, such as infection, bleeding and pain. Otherwise, since this is a surgical intervention on the testicle, there might be short-term sperm and hormone production problems. Although this risk is not high, hormone production might be possible since the micro-TESE operation might cause bleeding and tissue damage on the testicle.
The androgenic hormone testosterone might decrease after micro-TESE surgery. However, this will resolve between 6 to 8 weeks, and hormone production will return to normal. Checking for bleeding, applying ice to the bleeding region for 24 hours, not moving suddenly, keeping the testicles high, using comfortable underwear and using prescribed antibiotics will be enough for a smooth recovery process after micro-TESE surgery, which can be considered a medical gift for male infertility.
Process After Micro-TESE Surgery
Azoospermia, which is among the causes of male infertility, is no longer a problem for men who want to be fathers with micro-TESE surgery. The sperm quality of the patient and the clinic selected for the operation increases the success rate.
Good sperm selection is also an important factor in the success rate. This treatment gives hope to couples who want to be parents, and the post-op process is not tiring. The factors to consider after micro-TESE surgery are as follows:
- Patients can consume liquid food 3 hours after surgery.
- Patients can take baths for the first time 5 days after the surgery.
- Patients should avoid sex for 10 days.
- The patient should avoid heavy tasks for 10 days.
- Painkillers will be sufficient for the pain.
- Patients must inform their doctors if there is redness, bleeding and swelling around the surgery area.
- Micro-TESE surgery does not involve removing stitches. The stitches will be absorbed in a week.
- Patients must follow general hygiene rules.
Micro-TESE Surgery’s Price
Micro-TESE surgery increases the chance for men with infertility problems to become fathers. There is no other treatment method for men who cannot achieve results with this last-resort operation. The surgery can be defined as collecting the sperm for in vitro fertilization inside the testicle, though one of the most common questions about the surgery is the price.
It is hard to give an exact micro-TESE surgery price. Each clinic has different standards. The equipment, the health clinic selected for the operation, the surgeon and many other factors will change the micro-TESE surgery’s price, and the price can only be settled after a face-to-face examination.