What is microTESE?
MicroTESE stands for microdissection testicular sperm extraction. It’s a surgical procedure used to retrieve sperm from the seminiferous tubules of a male’s testes. MicroTESE is a highly specialized procedure that is not offered everywhere across the United States. It requires a very specific set of equipment, staff, expertise, and specialized laboratories to “navigate the complexities and challenges of the procedure to maximize chances of successful sperm extraction” (UPMC).
Testicular tissue with sperm is extracted with a small incision or a needle and then is examined for viable sperm. Sperm found during a microTESE procedure must be used for IVF, usually along with intracytoplasmic sperm injection (ICSI) because the sperm found inside the testis has not yet learned how to swim, and can’t fertilize an egg if it’s just placed inside the uterus.
As men with Klinefelter syndrome get older their seminiferous tubules deteriorate, so it’s suggested the younger a man is, the better the chances of finding sperm. There are studies that show a significant decrease in the success of microTESE over age 35. The success rate of extracting sperm via microTESE is about 55% or less. There are no predictive factors that doctors can use to determine whether or not the microTESE procedure will be successful.
In order to undergo a microTESE procedure, you will be placed under general anesthesia. The doctor will make a small (2-3cm) incision along the midline of your scrotum. The doctor will then open your testicles through that incision and look with a high-powered microscope for seminiferous tubules that are swollen and may contain sperm. A tissue sample will be taken from the tubules. Any bleeding that occurs will be stopped with cauterization. The doctor will repeat this process on both testicles, and then suture the incision with a dissolving stitch. The procedure can take 1-4 hours depending on the size of the testicles and how long it takes the doctor to locate areas of sperm production.
After the procedure, your tissue samples will be given to an andrology technologist who may spend 10-14 hours searching through the samples with a microscope to find viable sperm. If sperm is detected, it will be extracted from the sample and frozen in liquid nitrogen, to be used later for IVF.
According to the University of Utah, risks for undergoing microTESE can include:
- skin or testicle infections
- inability to find sperm
- transmission of a potential genetic cause of infertility to any offspring resulting from the use of the sperm
- testicle damage
- risks of general anesthesia
For 24 hours after surgery, you will use an ice pack to manage the swelling, as well as take a combination of ibuprofen and acetaminophen to reduce discomfort. Scrotal swelling is to be expected with a microTESE procedure and may take weeks to go down fully. You may be prescribed narcotics as an additional pain reliever. It’s highly recommended to avoid sex, masturbation, and vigorous activity for 10 days after surgery, to allow your testicles to fully heal. A jockstrap or tight underwear will support your scrotum and aid in the recovery process.
The costs associated with the microTESE procedure may widely vary depending on the medical facility, and insurance coverage. In addition to the microTESE procedure, associated costs may include the freezing a storage of extracted sperm, and the ICSI and IVF procedures for the female partner. The procedure may range from $2,500-$10,000 or more and include:
- Clinical consultations
- Semen analysis
- General anesthesia
- microTESE procedure
For Your Consideration
This procedure is complicated and can be very taxing for the patient, surgeon, and hospital (UPMC). There’s no conclusive evidence about how successful a microTESE procedure will be in locating viable sperm, or about how likely it will be to successfully conceive and carry a pregnancy.
Additionally, the true rates of genetic abnormalities in children fathered by men with KS are not yet fully understood, so extensive genetic testing should be offered to couples who use sperm collected from a microTESE to fertilize an egg (https://pubmed.ncbi.nlm.nih.gov/23493114/)