Testicular Sperm Extraction (TESE)

About Testicular Sperm Extraction (TESE)

Testicular sperm extraction (TESE) is a surgical procedure where a small portion of tissue is removed from the testicle. From this tissue, viable sperm cells are extracted for use in further procedures, most commonly intracytoplasmic sperm injection (ICSI) as part of in vitro fertilization (IVF).

What is a TESE?

Testicular sperm extraction (TESE) is a surgical procedure where a small portion of tissue is removed from the testicle. The goal is to obtain viable sperm cells for use in further procedures, most commonly intracytoplasmic sperm injection (ICSI) as part of in vitro fertilization (IVF). TESE is performed for various reasons, including:

• Obstructive Azoospermia: When there's an absence of sperm in semen due to blockage (e.g., history of vasectomy or congenital absence of the vas deferens).

• Spermatogenic Failure: In cases where natural sperm production is insufficient for fertilization.

• Cancer Patients: TESE with sperm cryopreservation allows cancer patients to preserve sperm for future assisted reproduction.

The procedure involves making a small incision on the front of the scrotum, revealing the testicle. Seminiferous tubules are then excised, and trained specialists extract sperm. These retrieved sperm can be used for IVF with ICSI or cryopreserved for future use. Because the number of sperm obtained through TESE is limited, they are often combined with eggs using ICSI. 

What is micro-TESE? 

Microsurgical Testicular Sperm Extraction (micro-TESE) is a surgical procedure used to retrieve sperm directly from the testicular tissue. It is primarily employed for men with non-obstructive azoospermia, a common cause of male infertility. In non-obstructive azoospermia, the absence of sperm in semen results from impaired sperm production within the testicles rather than blockages in the reproductive tract. Here's how micro-TESE works:

• Purpose: The primary goals of micro-TESE are to: Obtain the highest quality sperm. Retrieve enough sperm to fertilize a healthy female egg. Minimize damage to the reproductive organs. Preserve fertility for men who wish to have biological children.

• Procedure: A urologist performs micro-TESE in an operating room under general anesthesia. Using a high-magnification microscope, the surgeon meticulously examines the seminiferous tubules within the testicles. The goal is to identify pockets of viable sperm. Tiny tissue samples are then extracted for testing and sperm retrieval.

• IVF and Beyond: The retrieved sperm can be used for in vitro fertilization (IVF). During IVF, sperm are directly injected into an egg (intracytoplasmic sperm injection, or ICSI). Micro-TESE allows men with non-obstructive azoospermia to have a chance at biological parenthood.

Who is a Good Candidate for TESE?

Testicular Sperm Extraction (TESE) is a surgical procedure used to collect sperm directly from the testicles. It's typically recommended for specific situations:

• Non-obstructive Azoospermia: TESE is ideal for men with non-obstructive azoospermia, where the absence of sperm in semen results from impaired sperm production within the testicles rather than blockages in the reproductive tract. In such cases, TESE provides a chance to retrieve viable sperm for assisted reproduction.

• Low Sperm Count: Men who produce low sperm count benefit from TESE and its variant, microsurgical testicular sperm extraction (micro-TESE). These procedures extract sperm directly from the testes, bypassing the need for sperm to appear in semen.

• Preserving Fertility: TESE is crucial for cancer patients facing treatments that may affect fertility. By banking sperm before treatment, they increase their chances of having biological children in the future using their own sperm.

Testicular Sperm Extraction (TESE) Procedure

TESE Process

Testicular Sperm Extraction (TESE) is a surgical procedure used to retrieve sperm directly from the testicular tissue. Here's how it works:

• Incision: A small cut is made on the front of the scrotum to reveal the testicle.

• Tissue Excision: The outer layer of the testicle is opened, and seminiferous tubules (sperm-producing structures) are carefully excised.

• Sperm Extraction: Trained andrology specialists extract sperm from the obtained tissue.

• Purpose: TESE is commonly performed for men with non-obstructive azoospermia, where sperm production within the testicles is impaired. It provides a chance for assisted reproduction, especially when sperm are absent in semen.

• IVF Integration: The retrieved sperm can be used for in vitro fertilization (IVF), where they are directly injected into eggs (intracytoplasmic sperm injection, or ICSI).

The Benefits of Doing TESE

Testicular Sperm Extraction (TESE) is a surgical procedure that directly retrieves sperm from the testicular tissue. The main benefits of TESE include:

• Increased Chance of Fatherhood: TESE allows men with non-obstructive azoospermia (absence of sperm in semen) to have a better chance of having a biological child. By obtaining viable sperm directly from the testicles, it overcomes the limitation of low sperm count or poor sperm quality.

• Quality Sperm Retrieval: The procedure aims to obtain the highest-quality sperm, crucial for successful fertilization during in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). This ensures better chances of a successful pregnancy.

• Minimized Damage: Unlike other techniques, micro-TESE minimizes damage to the testicular blood supply and reduces tissue loss. It also ensures less blood in the biopsy specimen, improving safety and outcomes.

Testicular Sperm Extraction (TESE) in Iran

Equipped hospitals, and advanced specialized centers with experienced doctors and specialists are available in all medical treatment areas in Iran. Also, good hotels and entertainment centers have made Iran an appropriate choice for patients who are struggling with getting pregnant and need TESE treatment.

TESE Success Rates in Iran 

In Iran, the success rates of Testicular Sperm Extraction (TESE) vary based on the specific technique used and the patient's condition. Here are some insights:

• Microsurgical TESE (micro-TESE): A study conducted at the Yazd Reproductive Sciences Institute found that the success rate of micro-TESE was approximately 38%. Among men with non-obstructive azoospermia (NOA), successful fertilization occurred in 85.4%, biochemical pregnancy in 22.3%, clinical pregnancy in 22.3%, and live birth in 10.7% of cases. This technique involves meticulous tissue exploration under a microscope to retrieve viable sperm directly from the testicles.

• Age and Hormonal Factors: Interestingly, the success rate was higher in older men, emphasizing that age plays a role. Additionally, men with lower follicle-stimulating hormone levels had better outcomes.

• Overall Favorable Outcomes: For men with NOA, the chance of successful sperm retrieval approaches over 90%. During micro-TESE, surgeons find usable sperm in 73% of cases, making it a promising option for fertility treatments such as IVF, ICSI, or sperm cryopreservation.

TESE costs in Iran 

Microsurgical Testicular Sperm Extraction (micro-TESE) is an effective procedure for treating male infertility. In Iran, it is an attractive option due to its affordability and skilled medical professionals. Micro-TESE in Iran is significantly more affordable than in developed nations like the United States or Europe.  Iran offers micro-TESE procedures for approximately around 1200-1500 USD. Iran's treatment prices are remarkably reasonable compared to affluent countries. Choosing Iran for your treatment guarantees access to highly trained specialists ensuring quality care. During the procedure surgeons find usable sperm in 73% of micro-TESE procedures.