Mic  Micro-dissection Testicular Sperm Extraction   (Micro-TESE) Dr. Vishal Dutt Gour, MBBS, MS, MCh (Urology) Director, SCI International Hospital M-4,GK-1,New Delhi-48 Learning Objectives  Understand the difference between obstructive (OA)  and non-obstructive azoospermia (NOA)  Overview of sperm retrieval techniques for NOA (micro -TESE) and how to handle testicular sperm for ICSI Learn the success rates and prognostic factors of sperm  retrieval in NOA using micro-TESE Reproductive potential of Azoospermic men undergoing  assisted conception  Azoospermia •It is not a synonymous of sterility  Obstructive •Normal sperm production Mechanical blockage Vasectomy, Post-infectious, Congenital Non-obstructive Sperm production deficient or absent Cryptorchidism, Orchitis, Radiation, Chemotherapy, Trauma, Genetic, Gonadotoxins, Idiopathic INTRODUCTION •Microsurgical Testicular Sperm Extraction or “Micro- TESE” has been developed to detect sperm in the  testicles of men who have poor sperm production. •Because the testicular tubules are microscopic  structures, they cannot be distinguished by the naked  eye. •There is a higher chance that he will find sperm in  “fuller,” more normal tubules than in scarred or fibrotic  tubules. Microscope- why a good one is required Approach •Always plan to follow gradual stepwise approach to retrieve  sperm •Percutaneous  Semineferous Biopsy 3 to 4 sites using 18/20 G  Scalp Vein •Deliver the testis and do a mapping to check •Proceed with Micro TESA   •Micro-TESE can be performed as a diagnostic procedure  and if usable sperm are found, then they can be frozen  and the couple is recommended to proceed with ICSI.  •It can also be performed and timed with an egg  retrieval/IVF cycle so that the sperm are injected into the  eggs without freezing.  •Freezing the sperm from men with sperm production  problems can be difficult since these sperm are usually  few in number and don’t thaw well.  •Therefore the best chance of pregnancy is to use fresh sperm  obtained just prior to IVF. •The chance of finding sperm with Micro-TESE is better than  60%. This is twice the chances of finding sperm by non- microsurgical or needle biopsies taken by general urologists.  Micro-TESE is a great advance in male reproductive surgery, but  is only performed by a small number of male reproductive  surgeons.

1. Dr. Vishal Dutt Gour,
MBBS, MS, MCh (Urology)
Director, SCI International Hospital
M-4,GK-1,New Delhi-48
Micro-dissection Testicular Sperm Extraction
(Micro-TESE)

2. Understand the difference between obstructive (OA)
and non-obstructive azoospermia (NOA)
Overview of sperm retrieval techniques for NOA
(micro-TESE) and how to handle testicular sperm for
ICSI
Learn the success rates and prognostic factors of sperm
retrieval in NOA using micro-TESE
Reproductive potential of Azoospermic men
undergoing assisted conception
Learning Objectives

3. Azoospermia
•It is not a synonymous of sterility
• Normal sperm production
• Mechanical blockage
• Vasectomy, Post-infectious,
Congenital
Obstructive
• Sperm production deficient or
absent
• Cryptorchidism, Orchitis,
Radiation, Chemotherapy,
Trauma, Genetic,
Gonadotoxins, Idiopathic
Non-
obstructive

5. • Microsurgical Testicular Sperm Extraction or “Micro-
TESE” has been developed to detect sperm in the
testicles of men who have poor sperm production.
• Because the testicular tubules are microscopic
structures, they cannot be distinguished by the naked
eye.
• There is a higher chance that he will find sperm in
“fuller,” more normal tubules than in scarred or fibrotic
tubules.

6. Microscope- why a good one is required

9. • Always plan to follow gradual stepwise approach to retrieve
sperm
• Percutaneous Semineferous Biopsy 3 to 4 sites using 18/20 G
Scalp Vein
• Deliver the testis and do a mapping to check
• Proceed with Micro TESA
Approach

10. • Micro-TESE can be performed as a diagnostic procedure
and if usable sperm are found, then they can be frozen
and the couple is recommended to proceed with ICSI.
• It can also be performed and timed with an egg
retrieval/IVF cycle so that the sperm are injected into the
eggs without freezing.
• Freezing the sperm from men with sperm production
problems can be difficult since these sperm are usually
few in number and don’t thaw well.

11. • Therefore the best chance of pregnancy is to use fresh sperm
obtained just prior to IVF.
• The chance of finding sperm with Micro-TESE is better than
60%. This is twice the chances of finding sperm by non-
microsurgical or needle biopsies taken by general urologists.
Micro-TESE is a great advance in male reproductive surgery, but
is only performed by a small number of male reproductive
surgeons.