Testicular Sperm Extraction or a testicular biopsy, also commonly known as TESE procedure, is a biopsy method for extracting sperm from the testicles. This is a more invasive procedure for the extraction of sperm from testicular tissue, during which it is taken in a greater volume than within TESA. A larger amount of the material makes it possible to send a part of the tissue for morphological study in order to clarify further treatment, while some of the sperm is taken for cryopreservation for subsequent use in an in vitro fertilization program.

Just like TESA, a TESE biopsy is performed under parenteral anesthesia. It takes the same amount of time (from fifteen to twenty minutes), and the patient can go home approximately one hour after the extraction. The results of the histological examination will be known in about five to seven days.

Micro-TESE has several advantages:

• the number of spermatozoa in a received sample is about 60% against 30-32% in other methods;
• it minimizes the risk of concomitant damage to the testicle and its circulatory system.

TESE Features

During the procedure, microsurgical incisions are performed on one or both testicles, through which a surgeon receives tissue sections with seminiferous tubules containing spermatozoa. The extraction of sperm from the seminiferous tubules is performed immediately after that. If the testicular biopsy is not carried out in an in vitro fertilization cycle, the spermatozoa can be cryopreserved. After defrosting them, when the egg is ready, fertility specialists will perform fertilization.

Advantages of the TESE procedure:

• Sparing technique: spermatozoa are not injured with a needle, as it is possible during an aspiration biopsy;
• Application of TESE + IVF: when planning IVF after TESE, spermatozoa undergo a thorough investigation for infections, DNA fragmentation, and other risks;
• Accurate prognosis for infertility treatment: in case of injuries or complications after past diseases, it is possible to correct the cause of the sperm transport violation (microsurgical reconstruction of the vas deferens);
• High performance: a sufficient amount of material is collected to select viable sperm.

Indications for TESE

The procedure can be recommended for the treatment of diseases that cause azoospermia (a condition where there are practically no viable spermatozoa in the semen):

• complications after surgical treatment of inguinal hernia or testicular edema;
• testicular injury;
• sclerosis of the vas deferens due to inflammation;
• cryptorchidism;
• inflammation of testicular tissue;
• testicular torsion;
• effects of drugs or radiation on the testicular tissue.

The procedure will be performed after consulting a fertility specialist. Based on IVF group professionals, there is only one contraindication to TESE – acute inflammatory diseases caused by viruses or bacteria.

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