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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Conception sounds like a simple process: the sperm swims to an egg, gets inside, and creates a baby. But there are a surprising number of things that can go wrong during the journey.
Sometimes there isn’t enough sperm released during ejaculation to fertilize an egg or sperm is blocked from being released. For that reason, there are special techniques healthcare providers can use to collect sperm directly from the source and use them to fertilize an egg. Enter TESE.
What is testicular sperm extraction?
Called TESE for short, testicular sperm extraction is a procedure used to collect sperm directly from the testicles rather than from ejaculation. A healthcare provider or specialist (urologist) performs this procedure, sometimes right in their office.
- Conventional TESE (cTESE): During cTESE, a small incision is made in the skin of the scrotum. A sample is then collected from the testicle and is analyzed to identify and collect sperm.
- Microscopic TESE (microTESE): This method involves making an incision in the scrotum and using a microscope to look more closely at the tubes where sperm develop (seminiferous tubules). It’s a more complex process and is done in the operating room under general anesthesia.
MicroTESE has a higher success rate than cTESE as more sperm can usually be retrieved (Bernie, 2015). Because of this, microTESE is often the first choice for sperm extraction procedures (Flannigan, 2017).
When is TESE recommended?
Testicular extraction may be recommended for people with no sperm in their ejaculate. Called azoospermia, this condition is seen in up to 15% of men with infertility (Tsujimura, 2007). There are two types of azoospermia (Cocuzza, 2013):
- Obstructive azoospermia (OA): In this case, a blockage prevents sperm from leaving the testicles and into the penis for ejaculation. The blockage can be caused by a build-up of scar tissue, previous surgery, infection, or other injuries. TESE can bypass the blockage to collect sperm for artificial insemination procedures like in vitro fertilization (IVF) and ICSI (intracytoplasmic sperm injection).
- Non-obstructive azoospermia (NOA): This is when testicles produce very little sperm or none at all. For some people, a few tubules in the testes still produce sperm, but it might not be enough to detect in a semen sample. TESE can be helpful for identifying which tubules are functioning so sperm can be retrieved directly from them and then used to fertilize an egg.
When do men stop producing sperm?
TESE is sometimes used to help preserve fertility in people with certain medical conditions. For example, people with cancer may undergo TESE before receiving radiation or chemotherapy which may harm sperm production (Guo, 2018).
TESE is also helpful for male-to-female transgender individuals. Hormones given during their transition may damage testicular tissue, so TESE can be done beforehand to preserve fertility (Liu, 2019).
Other sperm retrieval procedures
TESE is often a first-choice procedure, but others are available, depending on the situation. Some other options for sperm retrieval include (Esteves, 2011):
- TESA (testicular sperm aspiration): This procedure is similar to TESE, except there’s no open incision. During TESA, sperm are removed from the testicles using a needle. One downside to TESA is sometimes it doesn’t retrieve enough sperm and you need to have a TESE done afterward.
- PESA (percutaneous epididymal sperm aspiration): In PESA, a needle is used to collect sperm from the small tube (epididymis) that sperm travel through for ejaculation. PESA can retrieve sperm unable to exit the testes because of a blockage, so it’s useful for obstructive azoospermia, but not for people with non-obstructive azoospermia.
- MESA (microsurgical epididymal sperm aspiration): This procedure is also helpful for people with obstructive azoospermia. The MESA method collects sperm from the epididymis through an incision. Since there’s an open incision involved rather than just a needle, you might feel a little more discomfort after it’s done.
Freezing sperm: cost, effectiveness, where to store it
Conceiving may be challenging when you don’t have enough sperm in your ejaculate or if something is blocking their way out.
Procedures like TESE may be able to help by collecting sperm right from the testicles. If you have questions about fertility, a good first step is speaking to a healthcare provider or fertility specialist for advice.
- Bernie, A. M., Mata, D. A., Ramasamy, R., et al. (2015). Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertility and Sterility, 104(5), 1099–103.e1033. doi:10.1016/j.fertnstert.2015.07.1136. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26263080/
- Cocuzza, M., Alvarenga, C., & Pagani, R. (2013). The epidemiology and etiology of azoospermia. Clinics, 68(1), 15–26. doi:10.6061/clinics/2013(sup01)03. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583160/
- Dabaja, A. A. & Schlegel, P. N. (2013). Microdissection testicular sperm extraction: an update. Asian Journal of Andrology, 15(1), 35–39. doi:10.1038/aja.2012.141. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739122/
- Deruyver, Y., Vanderschueren, D., & Van der Aa, F. (2014). Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology, 2(1), 20–24. doi:10.1111/j.2047-2927.2013.00148.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24193894/
- Esteves, S. C., Miyaoka, R., & Agarwal, A. (2011). Sperm retrieval techniques for assisted reproduction. International Brazilian Journal of Urology, 37(5), 570–583. doi:10.1590/s1677-55382011000500002. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22099268/
- Ezeh, U. I., Moore, H. D., & Cooke, I. D. (1998). A prospective study of multiple needle biopsies versus a single open biopsy for testicular sperm extraction in men with non-obstructive azoospermia. Human Reproduction, 13(11), 3075–3080. doi:10.1093/humrep/13.11.3075. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9853859/
- Flannigan, R., Bach, P. V., & Schlegel, P. N. (2017). Microdissection testicular sperm extraction. Translational Andrology and Urology, 6(4), 745–752. doi:10.21037/tau.2017.07.07. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583061/
- Gies, I., Oates, R., De Schepper, J., et al. (2016). Testicular biopsy and cryopreservation for fertility preservation of prepubertal boys with Klinefelter syndrome: a pro/con debate. Fertility and Sterility, 105(2), 249–255. doi:10.1016/j.fertnstert.2015.12.011. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26748226/
- Gnessi, L., Scarselli, F., Minasi, M. G., et al. (2018). Testicular histopathology, semen analysis and FSH, predictive value of sperm retrieval: supportive counseling in case of reoperation after testicular sperm extraction (TESE). BMC Urology, 18(1), 63. doi:10.1186/s12894-018-0379-7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032772/
- Guo, D. P. & Hwang, K. (2018). Optimizing fertility preservation with microscopic onco-testicular sperm extraction. Fertility and Sterility, 109(4), 625–626. doi:10.1016/j.fertnstert.2018.02.010. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29653716/
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- Jarow, J. P., Espeland, M. A., & Lipshultz, L. I. (1989). Evaluation of the azoospermic patient. The Journal of Urology, 142(1), 62–65. doi:10.1016/s0022-5347(17)38662-7. Retrieved from https://pubmed.ncbi.nlm.nih.gov/2499695/
- Liu, W., Schulster, M. L., Alukal, J. P., et al. (2019). Fertility Preservation in Male to Female Transgender Patients. The Urologic Clinics of North America, 46(4), 487–493. doi:10.1016/j.ucl.2019.07.003. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31582023/
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Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.