Microdissection TESE (MD TESE, Micro TESE) is a sperm retrieval method. It is very similar to testicular sperm extraction (TESE), but employs a surgical microscope as part of the procedure. It is an infertility treatment a step before IVF with ICSI (microinjection). Microdissection TESE is a relatively new technique (it was first reported in 1999) that is based on the idea that seminiferous tubules containing sperm cells larger and whiter than the surrounding tubules. These tubules can be seen with an operating room microscope.
Microdissection TESE is coordinated with the female partner’s egg retrieval so the couple can support each other during the procedures. Sperm retrieval is usually carried out on the same day or the day before egg retrieval. Patients who undergo Microdissection TESE do not normally have the option of freezing their sperm for future use because the sperm is immature and may not survive the cryopreservation process. In fact, freezing sperm obtained from Microdissection TESE dramatically reduces the chances of successful fertilization later.
Microdissection TESE results in the removal of only a small amount of testicular tissue with maximal sperm yield. It also minimizes the negative impact on testicular function. Microdissection TESE is an alternative to traditional TESE which requires a number of “blind” testis biopsies resulting in an excision of a large volume of testicular tissue. This, in turn, can lead to permanent damage to the testis. The results of Microdissection TESE are more successful than conventional TESE because Microdissection samples yield more sperm cells from smaller samples.
Microdissection TESE is suitable for retrieving sperm in men with testis failure or non-obstructive azoospermia (sperm production is too low to ejaculate). It is best to undergo fertility testing so you can determine the nature of your infertility before making any decisions regarding treatment. Your infertility specialist will help explain the options available to you.
The total cost of Microdissection TESE can vary depending on the location or clinic. Some countries charge exorbitant fees while others are significantly more affordable. Many couples seeking infertility treatments will find Turkey, Cyprus, Armenia and Mexico cost-effective medical tourism destinations.
Once you have undergone infertility testing to work out why you and your partner have been unable to conceive, your doctor will discuss the various infertility treatment options available to you. In cases where there is a male factor cause of infertility, sperm retrieval methods will be where you start.
Not all men are good candidates for Microdissection TESE. Some men are better suited to other sperm extraction techniques such as Percutaneous Epididymal Sperm Freezing (PESA) or Testicular Sperm Aspiration (TESA).
There are a number of advantages and disadvantages of the Microdissection TESE procedure. It is important to weigh these up so you feel comfortable enough to undergo the relatively invasive surgery.
Men Who Are Good Candidates For Microdissection TESE
· Men with non-obstructive azoospermia (sperm production is too low to even reach the ejaculate)
· Men with hypospermatogenesis (abnormally decreased production of sperm cells)
· Men with Sertoli cell only syndrome (disorder characterized by absent seminiferous tubules)
· Men with Klinefelter’s syndrome (male genetic disorder characterized by small testes and decreased infertility)
· A good candidate for Microdissection TESE may be someone who has unsuccessfully undergone standard Testicular Sperm Extraction (TESE)
Men Who Are NOT Good Candidates For Microdissection TESE
· Men with obstructive azoospermia
· Men who are unable or unwilling to accept a potential failed sperm extraction. They need to have realistic expectations of this procedure: its capabilities, limitations, risks and side effects.
The Microdissection TESE procedure is performed in an operating room with general anesthesia. The testis is cut open with a single incision, testicular tissue is extracted and then the testis is stitched closed. The testicular tissue is then placed in a culture medium and processed accordingly. This sperm retrieval technique makes it possible to obtain sperm from men who would otherwise be unable to have IVF with ICSI (microinjection).
It is a much more efficient sperm retrieval method than conventional Testicular Sperm Extraction (TESE) – especially in men with non-obstructive azoospermia. The Microdissection TESE procedure allows the removal of tiny volumes of testicular tissue containing sperm. It requires an operating microscope so the tubules containing sperm can easily be seen. Microdissection TESE will not be successful in men who have no enlarged tubules or whose enlarged tubules cannot be seen.
Advantages of the Microdissection TESE Procedure
· Just a single incision is made in the testis
· The use of the microscope allows the identification of blood vessels within the testicle so the risk of vascular injury is minimized
· As only selected tubules are biopsied, the total volume of tissue cut out is less than in the traditional multi-biopsy method
· Because there is less tissue to be examined, it is much easier for the embryologist to find sperm cells after the surgery
· Sperm retrieval rates are relatively high (43-63% in most cases)
· Micro-TESE results in fewer risks and side effects than other sperm retrieval methods. These complications include: acute epididymitis, scrotal haematoma, testicular hydrocele, intra-testicular scarring and post-operative hypogonadism.
· Microdissection TESE contributes to favorable pregnancy rates in patients
· The Microdissection TESE procedure is at least as safe if not safer than other sperm retrieval methods with only a 1-2% chance of testis loss
Disadvantages of the Microdissection TESE Procedure
· The Microdissection TESE procedure is surgically quite invasive
· Testis injury is a particular concern
· If both testicles are operated on, testosterone levels can drop to 20% of pre-procedure levels 3 to 6 months after sperm retrieval. However, there is a 95% return to baseline levels within 18 months.
· Sperm retrieval methods such as the Microdissection TESE procedure can lead to a7% decrease in seminiferous tubule volume and a 5% decrease in germ cell density within tubules. This implies that there is a lasting impact on testis function
· The operative time for the Microdissection TESE procedure is much longer than standard TESE