In some circumstances, a man’s ejaculate may contain very few healthy sperm or even no healthy sperm at all. This is referred to as azoospermia or oligospermia/cryptozoospermia. Reasons for this include
A blockage, severing or lack of the vas deferens;
An extremely reduced sperm production or no sperm production at all. This can be caused by, for example, genetic defects, environmental toxins, infections, an undescended testicle that was treated too late or varicose veins of the testicles.
Furthermore, a man may be unable to ejaculate, due to a tumor or paraplegia for example. In such cases, it’s usually impossible to conceive the ‘natural’ way.
In cases like the ones described above, there are often still viable sperm cells in the epididymides or testicles. It’s possible for a physician to retrieve these. One of the options is a procedure known as testicular sperm extraction (TESE). TFP MC Kinderwens works with several clinics that are capable of doing TESE treatments. A TESE won’t take place at TFP MC Kinderwens. If the TESE yields viable sperm cells, they can be used at our fertility centre to fertilize oocytes using an ICSI treatment.
If sperm cells are either not produced at all or incorrectly, it’s still possible for some sperm cells to be inside the testicles. These can be retrieved using testicular sperm extraction (TESE). In this procedure, the sperm cells are taken directly from pieces of testicular tissue.
TESE, also known as testicular biopsy, is performed under general anesthetic. During this procedure, the physician will use a thin biopsy needle to remove several small tissue samples, from one or both testicles. The procedure is performed on an outpatient basis and will take around ten minutes. The procedure can be repeated if necessary.
TESE is a treatment with very high odds of success; we obtain viable sperm cells in roughly 75 percent of cases. However, the likelihood of success is largely determined by the underlying cause of the lack of sperm in the ejaculate. Various examinations of the partner (hormone analyses, genetic studies, et cetera) can often be performed prior to the procedure, allowing us to predict the odds of success – for the TESE as well as a pregnancy after it.
Just like any other operation performed under anesthesia, there are certain risks involved with TESE, which your treating nurse or physician will explain in further detail. For example, in rare cases, there may be bleeding, bruising, swelling of the scrotum or an infection of the epididymis after the operation. Therefore, we generally advise patients to rest for five days after the surgery and wait to shower until at least the next day. You should avoid swimming or visiting the sauna for two weeks after the operation.
The testicle tissue samples retrieved using a TESE treatment are immediately prepared, processed and examined in the laboratory. If viable sperm cells are found, they are generally initially frozen in liquid nitrogen (cryopreservation).
The number of viable sperm cells obtained using TESE is usually fairly low, and incapable of fertilizing an oocyte by themselves. Therefore, the partner’s oocytes are usually fertilized using an intracytoplasmic sperm injection (ICSI).
In the Netherlands, a TESE treatment will be covered by insurance. Our physicians will gladly provide further information.