Testicular biopsy (TESE)

Testicular sperm extraction is a surgical procedure used to retrieve sperm from the testes (site of production) as opposed to from an ejaculate. This sperm is then used fertilize eggs in an IVF cycle using the technique of intracytoplasmic sperm injection (ICSI - injecting one good looking sperm into each mature egg).

There are two main types of TESE:

• Open biopsy: This is a surgical procedure in which a small incision is made in the scrotum and a piece of testicular tissue is removed.
• Micro-TESE: This is a minimally invasive procedure in which a needle is inserted into the testicle and a small amount of testicular tissue is removed under microscopic guidance.

The type of TESE performed depends on the individual's needs and history. Some indications for TESE include:

• Azoospermia: TESE is often performed when a man has no sperm present in his ejaculate. Azoospermia can be classified into two types:
  • Non-obstructive azoospermia (NOA): In this condition, the testes do not produce sperm due to genetic factors, testicular injury, or other medical conditions.
  • Obstructive azoospermia (OA): In this condition, the testes produce sperm, but the pathway to the urethra is blocked (ie. congenital bilateral absence of the vas deferens (CBAVD) in cystic fibrosis). TESE can help retrieve sperm directly from the testicles in this case.
• Previous vasectomy: Men who have undergone a vasectomy and wish to have children again may opt for TESE to retrieve sperm from their testes for use in an IVF cycle as opposed to having a vasectomy reversal.
• Testicular dysfunction: Some medical conditions, such as hormonal imbalances or Klinefelter syndrome, or toxic exposures, such as chemotherapy or radiation, can lead to impaired sperm production. TESE may be an option to retrieve viable sperm in these cases.

The success of TESE depends on various factors, including the underlying cause of sperm production issues, the expertise of the surgeon, and the availability of assisted reproductive technologies like IVF and ICSI. The average success rate for obtaining sperm is 70%.

While TESE is a safe procedure, there are some associated risks. These risks include:

• Pain: There may be some pain after the procedure. Most patients report mild discomfort that is managed with medication.
• Infection: There is a small risk of infection after the procedure. This risk can be minimized by taking antibiotics before and after the procedure.
• Scarring: There may be some scarring at the incision site. This scarring is usually minor with no long-term impact to testicular hormone production.

We refer our patients who need TESE to our Urology colleagues, who have extensive experience with this specialized procedure. We work closely with them to time the TESE with an IVF cycle if fresh TESE and ICSI is planned. We sometimes opt to freeze the sperm samples if ICSI is not planned immediately.

If you are considering TESE we are happy to discuss options and potential outcomes to help you make an informed decision about your fertility treatment.