TESA/ Microtese

For couples navigating the intricate journey of infertility, advancements in medical science offer promising solutions. Today, we delve into the intricacies of Testicular Sperm Aspiration (TESA) and Microdissection Testicular Sperm Extraction (MicroTESE), two groundbreaking procedures reshaping the landscape of assisted reproduction. And who better to guide us through this revolutionary terrain than Dr. Sunita Arora, renowned for her expertise as Delhi's foremost gynecologist.

Understanding TESA

Testicular Sperm Aspiration (TESA) is a minimally invasive procedure used to retrieve sperm directly from the testicles of men with obstructive azoospermia or non-obstructive azoospermia. Azoospermia refers to the absence of sperm in the ejaculate, which can be caused by various factors such as blockages in the reproductive tract or impaired sperm production in the testes.

Process of TESA

• Local Anesthesia: TESA is typically performed under local anesthesia to minimize discomfort during the procedure. The patient remains awake while the scrotum is numbed with a local anesthetic injection.
• Testicular Aspiration: Using a thin needle attached to a syringe, the fertility specialist punctures the skin of the scrotum and enters the testicle to aspirate (suction) small tissue samples containing sperm. Multiple aspirations may be performed to collect an adequate number of sperm for fertility treatment.
• Sperm Retrieval: The tissue samples obtained through TESA are processed in the laboratory to isolate viable sperm for use in assisted reproductive techniques such as Intracytoplasmic Sperm Injection (ICSI), where a single sperm is injected directly into an egg to achieve fertilization.

Indications for TESA

• Obstructive Azoospermia: TESA is commonly used to retrieve sperm in cases where the production of sperm is normal but there is a blockage preventing sperm from reaching the ejaculate. This can occur due to conditions such as congenital absence of the vas deferens (CAVD), prior vasectomy, or scarring from infection or surgery.
• Non-obstructive Azoospermia: In some cases of non-obstructive azoospermia, where sperm production is impaired within the testes, TESA may be attempted to retrieve any remaining viable sperm for fertility treatment.

Benefits and Considerations for TESA

• Minimally Invasive: TESA is a minimally invasive procedure that can be performed on an outpatient basis, requiring only local anesthesia and a short recovery period.
• Potential for Sperm Retrieval: TESA offers hope for men with obstructive or non-obstructive azoospermia by providing a means to retrieve sperm directly from the testes for use in assisted reproductive techniques.
• Variable Success Rates: The success of TESA depends on various factors, including the underlying cause of azoospermia, the quality and quantity of sperm retrieved, and the expertise of the fertility specialist. Success rates for sperm retrieval may vary, particularly in cases of non-obstructive azoospermia where sperm production within the testes is impaired.

Understanding MicroTESE

Microdissection Testicular Sperm Extraction (MicroTESE) is an advanced surgical technique used to identify and retrieve sperm from the testicles of men with non-obstructive azoospermia. Unlike traditional TESE procedures, which involve random biopsies of testicular tissue, MicroTESE utilizes high-powered optical magnification and microsurgical techniques to selectively identify areas of active sperm production within the testes.

Process of MicroTESE

• Surgical Exploration: Under general anesthesia, a small incision is made in the scrotum to expose the testicle. Using an operating microscope, the fertility specialist meticulously examines the testicular tissue to identify regions with signs of sperm production, such as dilated tubules or healthy-looking seminiferous tubules.
• Sperm Retrieval: Once areas of active sperm production are identified, tiny samples of testicular tissue containing sperm are carefully dissected and removed for further processing in the laboratory.
• Sperm Analysis: The tissue samples obtained through MicroTESE are analyzed to identify viable sperm for use in assisted reproductive techniques such as ICSI.

Indications for MicroTESE

• Non-obstructive Azoospermia: MicroTESE is primarily indicated for men with non-obstructive azoospermia, where sperm production within the testes is impaired. This condition may result from genetic factors, hormonal imbalances, or other underlying causes affecting spermatogenesis.
• Prior Failed Sperm Retrieval: MicroTESE may be recommended for men who have undergone previous unsuccessful attempts at sperm retrieval using conventional TESE or other methods.

Benefits and Considerations for MicroTESE

• Increased Sperm Retrieval Rates: MicroTESE offers higher sperm retrieval rates compared to traditional TESE procedures, as it allows for the selective identification and extraction of areas with active sperm production within the testes.
• Minimally Invasive Approach: Despite being a surgical procedure, MicroTESE is considered minimally invasive, with smaller incisions and reduced tissue trauma compared to open surgery.
• Expertise Required: MicroTESE requires specialized training and expertise in microsurgical techniques and testicular anatomy. It is essential to seek treatment from a fertility specialist with experience in performing MicroTESE procedures to optimize outcomes.
• Potential for Future Fertility: By successfully retrieving viable sperm from the testes, MicroTESE provides hope for men with non-obstructive azoospermia to achieve biological fatherhood through assisted reproductive techniques.

TESA and MicroTESE are invaluable techniques that offer hope to men with impaired sperm production, enabling them to pursue parenthood through assisted reproductive techniques. Whether it's retrieving sperm from obstructive azoospermia using TESA or selectively extracting sperm from non-obstructive azoospermia with MicroTESE, these procedures play a crucial role in overcoming male infertility challenges.

In the realm of fertility treatment, Dr. Sunita Arora stands as a beacon of hope, illuminating the path for couples yearning for parenthood. Through her mastery of TESA and MicroTESE techniques, coupled with her compassionate care, Dr. Arora continues to rewrite the narrative of infertility, turning dreams into reality and nurturing the miracle of life.

In the corridors of her clinic, hope springs eternal, fueled by unwavering dedication and the promise of tomorrow. With Dr. Arora by their side, couples embark on a transformative journey, embracing the dawn of parenthood with renewed optimism and profound gratitude.