micro-TESE, PESE, TESA, PESA, Vaso-epididymal anastomosis

microTESE (microsurgical sperm retrieval)

 

Our clinics specialize in unique treatment of male factor infertility, azoospermia. Azoospermia is a disease, where there are no sperm cells in the ejaculate.

 

What is micro-TESE
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Nowadays, microsurgical sperm retrieval (or micro-TESE) is the most effective method for obtainment of sperm cells in case if a man had been diagnosed with poor quality of sperm and conservative treatment of azoospermia yields no result.

micro-TESE is minimally invasive surgery, involving testicular biopsy (collection of a part of biological material). It allows men with the most severe types of infertility to become fathers.

This surgery increases chances of detection of sperm cells in patients with azoospermia by 80%.

 

Indications for micro-TESE

The main factor of man’s reproductive health is preservation of spermatogenesis. Spermatogenesis represents maturation of sperm cells which continues practically throughout the entire life of a man in the absence of adverse effects. At the same time, a growing number of young and middle-aged men suffer from the small number of motile sperm cells and/or poor quality of sperm.

Spermogram and a number of laboratory assessments and ultrasound examinations allow to determine the state of spermatogenesis. If spermatogenesis is impaired and the results of diagnosis show absence of sperm cells, this entails presence of secretory (non-obstructive) azoospermia. However, sometimes it happens that spermatogenesis is preserved, sperm cells are formed, but they do not appear in the ejaculate. In this case, there is excretory (obstructive) azoospermia. In both cases, conception without medical help is not possible.

If a patient is diagnosed with azoospermia, and its treatment yields no result, micro-TESE becomes the method of choice. Modern reproductive medicine allows collection of sperm cells directly from the testicle. Surgical retrieval of sperm cells is effective in severe impairment of spermatogenesis and when a man has very few viable sperm cells.

 

Indications for surgical sperm retrieval

  • Non-obstructive azoospermia.
  • Genetic disorders.
  • Impaired function of testicles in the setting of inflammatory diseases, previous chemotherapy or long-standing varicocele.
  • Obstructive azoospermia.
  • History of vasectomy.
  • Structural congenital abnormalities of reproductive system organs.
  • Previous traumas and surgical interventions that caused obstruction of the deferent canal.
  • History of epididymitis.

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micro-TESE is performed under the control of high-precision optical equipment, a special microscope, which magnifies view of the operative field by 25 times. This allows selection of the most promising areas for puncture where maturation of sperm cells is possible. A surgeon-andrologist opens testicular tissue and examines testicular canals, searching for sites, where sperm cells could be present.

In patients with non-obstructive (secretory) azoospermia, normal maturation of sperm cells occurs at small individual sites. When such site is detected, a surgeon separates a part of testicular tissue and right away gives cells to an embryologist, who immediately evaluates the sperm cells collected and announces results then and there. If quality of sperm cells is satisfactory, surgery is ended thereon. In other cases, a surgeon performs ultimate search for preserved tissue sites to collect sperm cells that are potentially suitable for further fertilization.

 

Examinations required prior to micro-TESE

  • Blood group, Rh-affinity.
  • Complete blood count.
  • Coagulogram.
  • Biochemical blood test.
  • Blood test for RW, HIV, hepatitis В, С (valid for 3 months).
  • ECG.
  • Urine analysis.
  • Chest X-ray.
  • Consultation of a therapist on absence of contraindications for surgical intervention.

 

 

micro-TESE procedure and results

micro-TESE may be carried out on the same day as follicles puncture in a woman. In this case, fertilization will be performed in a natural cycle without using cryopreservation of cells.

Additionally, micro-TESE can be carried out at any time that is convenient for a man. Sperm cells obtained during surgery are cryopreserved, and, subsequently, IVF is performed using the cryopreservation protocol.

 

Our clinics are specialized in methods for treatment of male infertility.

Urologists-andrologists have extensive experience and resort to surgical interventions only in extreme cases when conservative treatment methods turn out to be helpless.

 

 

 

TESA, PESA, TESE

 

TESA is closed percutaneous testicular puncture biopsy.

PESA is closed percutaneous epididymal biopsy.

These interventions can be performed in obstructive (excretory) azoospermia when sperm cells are normally produced in testicles and further mature in epididimes, but due to obstacles in deferent canals do not pass through them in a natural way. Congenital absence of ejaculatory ducts can also be the cause of obstructive azoospermia.

Using a puncture needle with a syringe, material, containing sperm cells, is retrieved from the testicle or its epididymis.

The surgery does not require any in-hospital observation.

 

TESЕ is open testicular biopsy.

It is performed in case of non-obstructive (secretory) azoospermia or if attempts to collect material using TESA and PESA were unsuccessful.

This surgery is carried out in a clinical setting under general anesthesia. A small incision is made on the scrotum, and a portion of the testicle is dissected away and given to an embryologist to find sperm cells.

The next day the patient can go home.

 

One of disadvantages of these procedures compared to micro-TESE is that testicular tissue is collected at random.

 

Vasoepididymoanastomosis is surgery to restore patency of deferent canals.



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