Introduction

*Azoospermia may be due to either abnormal sperm production (non-obstructive azoospermia) or normal sperm production in the presence of obstruction (obstructive azoospermia). In cases of obstructive azoospermia ICSI is advised using sperms that will be aspirated by means of needle aspiration (that usually do not need general anaesthesia) from the area before the obstruction.
In cases of abnormal sperm production is usually caused by testicular failure. Testicular failure affects approximately 1% of the male population and 10% of men who seek fertility evaluation. In these cases the hope depends on finding sperm in testicular tissue obtained by testicular biopsy (TESE). We have observed that direct evaluation of testis biopsy specimens often demonstrates sperm in men with non-obstructive azoospermia, despite severe defects in spermatogenesis.

What is TESE?

*TESE is a surgical sperm retrieval procedure used in fertility treatment for men who have no sperm in their ejaculate.

Who is TESE suitable for?

*TESE is used for men with both obstructive and non-obstructive azoospermia. These men have no sperm in their ejaculate because either there is a blockage in the route between the site of sperm production (the testes) and ejaculation or because there is a partial or complete failure in sperm production in the testes.

What does TESE involve?

*Under the care of a consultant andrologist, TESE is not a major procedure that be carried out under local anaesthesia. However, others would prefer to be carried out under general anaesthesia specially with the increased safety of general anaesthesia.
*Sperm are retrieved from the testes and can be used to achieve fertilisation of eggs in the laboratory. However, because the numbers of sperm that retrieved is often very low, it is necessary to combine TESE with ICSI.

Is there any advances in the technique of TESE?

*Microsurgical Testicular Sperm Extraction (Micro-TESE)
Micro-TESE is an advanced procedure that requires an expert micro-surgeon, and can make the difference between success and failure for many couples.
What Makes MicroTESE Successful?

*The chance of finding sperm with Micro-TESE is better than 60%.
*This is twice the chances of finding sperm by non-microsurgical method.
*The amount of testicular tissue taken is much less than the conventional TESE
* Most men are surprised by the minimal amount of pain they have after this surgery.

How can be the best sperm been selected?
There are new evidence a better sperm can be selected by magnifying the sperm head under the microscope to a magnification of x 6000 show minor defects in the sperm head.