Microdissection TESE
Explanation of Procedure
Microscopic or Microdissection Testicular Sperm Extraction (TESE) is a surgical procedure performed in the operating room under general anesthesia to retrieve sperm for IVF/ICSI. Microdissection TESE can improve sperm retrieval for men with non-obstructive azoospermia over those achieved previously with standard testis biopsy techniques.
As with the standard multi-biopsy approach, optical magnification via an operating microscope is used to visualize blood vessels under the surface of the tunica albuginea, the outside layer of the testis, allowing placement of the dissection to occur in bloodless regions of the testis. Instead of planning for multiple biopsies, a large incision is made in the midportion of the tunica albuginea to optimize visualization of the testicular parenchyma without affecting testicular blood supply. The testicular parenchyma is then directly examined with high-powered microscopy in an attempt to identify individual seminiferous tubules that are larger than other tubules in the testicular tissue. Small samples are sharply excised from these areas when the tubules appear larger and whiter. Each excised testicular tissue specimen is then dissected into smaller pieces and then examined for sperm. Additional dissections are made when sperm are retrieved or further sampling was thought likely to impair the testicular blood supply.
Microdissection is particularly useful to apply in men with smaller testes, as for example in men with Klinefelter’s syndrome. Microdissection is also easier to apply in cases of Sertoli-cell only pattern as there is a greater difference between tubular diameter size. In cases of maturation arrest, microdissection assists in identifying the limited regions of sperm production.
Outcomes
Schegel et al has reported for men with at least one area of hypospermatogenesis, 81% of men had sperm retrieval, whereas when the most advanced spermatogenesis form was maturation arrest, 42% of men has sperm retrieved. When the most advanced spermtogenic pattern was that Sertoli Cell-only, 24% of men have sperm retrieved. Microdissection TESE improves these sperm retrieval outcomes, and allows retrieval of sperm in men whom sperm retrieval was unsuccessful with standard TESE approaches Schlegel reports that sperm retrieval success increased from 45% to 63% after introduction of the microdissection technique.
Microdissection TESE is performed “fresh” at the time of egg retrieval, either the day before or day of. Cryopreservation of additional tissue is performed. Donor sperm backup is recommended to be used if no sperm are found on microdissection TESE.
Microdissection techniques make it feasible to retrieve sperm in men who would otherwise be unable to proceed with IVF/ICSI. Retrieval rates are improved, less testicular tissue is extracted and fertility is optimized for the infertile male. Careful coordination with the female partner’s reproductive endocrinologist is essential.
Schlegel PN: Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999, 14:131-135
Schlegel PN and Li, PS: Microdissection TESE: Testicular sperm retrieval in non-obstructive azoospermia. Video and abstract ( V-16) presented at the 94th annual meeting of American Urologic Association, May 1-6, 1999, Dallas, TX
Karen Elizabeth Boyle, M.D.
Reproductive Medicine & Surgery, Sexuality and Aesthetics
Contact Us
Karen E. Boyle, M.D.
Phone: 877-290-5055
Fax: 410-825-5811
Chesapeake Urology Associates at Greater Baltimore Medical Center (GBMC)
Physicians Pavilion North
6535 North Charles Street, Suite 625
Baltimore, MD 21204
