Microdissection Testicular Sperm Extraction (MicroTESE)

Using today's minimally invasive techniques, sperm can be obtained from men in many situations and used to directly fertilize a partner’s egg. For men with little or no sperm present in the semen, microdissection testicular sperm extraction (microTESE) may be used to find sperm in the testicle. Dr. Fenig is fellowship-trained in this procedure, which is more complex than older sperm extraction techniques but yields far better results.

MicroTESE has significantly improved sperm retrieval rates in men with no measurable levels of sperm in the ejaculate, and is a more accurate procedure since the entire testis is surveyed while less testicular tissue is removed.

Conventional TESE may require multiple testis biopsies to find sperm, with excision of large volumes (>700 mg) of testicular tissue. The microTESE technique performed by Dr. Fenig requires excision of a smaller testis volume. Some studies have shown that the procedure can increase retrieval rates from 45% with TESE to 63% with microTESE. According to one research paper, microdissected samples yielded an average of 160,000 spermatozoa per sample from only 9.4 mg of tissue, versus 64,000 with conventional biopsy samples, which also required biopsies of 720 mg*.

The Procedure

MicroTESE is performed by Dr. Fenig under general anesthesia, using an operating microscope. A small incision is made in the scrotum and Dr. Fenig examines the testis under a special microscope. After the testicular capsule has been opened, it is possible for Dr. Fenig to examine tiny tubules in the testicles, which often contain viable sperm, and identify the most robust ones. These are then removed and dissected, using a high-power microscope. A special laboratory process is used to search for sperm, and remove healthy ones.

Because sperm of compromised quality are not as sustainable when frozen, such as in patients with nonobstructive azoospermia, Dr. Fenig will typically coordinate the procedure with your partner’s ovulation cycle so that healthy eggs are available for in-vitro fertilization. The sperm are then injected directly into the egg, a procedure called intracytoplasmic sperm injection, or ICSI.

What to Expect Post-Operatively

Dr. Fenig will provide you with instructions to assist in your recovery from your scrotal surgery. Following are some general guidelines:

• Wear the scrotal support for at least one week following the procedure.

• Place an ice pack (a bag of frozen peas works well too) inside the scrotal support and on top of gauze dressing – change every hour until bedtime the day of the procedure.

• Keep the gauze and fluff dressing in place for one day.

• Relax and rest for one to two days following your procedure. Avoid excessive walking, sitting for prolonged periods of time, and unnecessary exertion. Your recovery will be quicker and easier if you take it easy for these days immediately post-op.

• Avoid exercise (no running, heavy lifting, straining, etc.) for one to two weeks. Avoid straddle activities like cycling, horseback riding for at least three weeks.

• It is expected to have a small amount of blood stain the gauze dressing. There may be some swelling and firmness at the site of the incisions.

• Take the antibiotic as prescribed to help prevent infection.

• You may take the narcotic medication as prescribed for discomfort or you may take extra-strength Tylenol as directed. Do not take any aspirin products for two weeks following the procedure.

• You may shower one day after the procedure– pat your scrotum dry, do not rub. Do not take a bath or go swimming for two weeks.

• Dr. Fenig uses absorbable sutures to close the incision. This suture dissolves on its own and does not need to be removed.

• Abstain from intercourse for at least one week or until discomfort resolves.