It’s another more complex form of testicular biopsy. It involves an andrologist or urologist who will operate the testicle and investigate for the presence of spermatozoa with the use of a microscope and the use of microscope aims to help the surgeon to identify the parts and the tubules, the testicular tubules that are better vascularized and have a more healthy appearance in an aim to identify the parts of the testicles that have a better chances to have an active spermatogenesis. Normally, next to the surgeon, there is an embryologist who has a good knowledge in processing the testicular tissues and investigating under the microscope for the presence of testicular spermatozoa. Micro TESE, today, is acknowledged as the best approach to investigate non-obstructive azoospermic men for the presence of spermatozoa because it’s more thorough and more detailed and by using micro TESE instead of conventional TESE, we increase the recovery rate of spermatozoa for non-obstructive azoospermic men up to 20 or 30% depending on the experience of the team supporting these approaches.
To recover sperm from men who’ve got a production type problem or perhaps they’ve had other sperm retrieval procedures that have failed. In a micro TESE in essence what happens is the testicles are opened up in an operating theater – usually while the patient is asleep and under an operating microscope. What you’re looking for is a discrepancy a difference in the thickness of the tubules within the testicle that little tiny tiny little kind of coiled up, little bits of string -these are the factories in which sperm are made and if you’re looking at these tubules, if they’re fat and juicy looking, they’re more likely contain sperm than if they’re thin and scarred. So with the aid of the microscope, you can look throughout the substance of the testicles to get the best bits out to recover sperm for ICSI treatment.
Men who have no sperm in their ejaculate (we call this azoospermia) can be due to different causes. So their option is to have surgical sperm retrieval, we perform an operation of the testicles and there are three ways of doing this. One is a less invasive method and we call it TESA – Testicular Sperm Aspiration and the other method is TESE where we slightly open the testicles but without the microscope and a tiny tissue that we give to the lab and they see whether there are sperms inside the testicle tissue or not. The other one is Micro TESE, where the surgeon has an operative microscope and they see with the help of the microscope, they open the testicle a bit more with more extensive surgery and the testicular tissue is in the from of tubules, so under the microscope a surgeon is better able to see those tubules and then they dissect those tubules and they can see whether those tubules contain sperm or not. It is a more refined, more detailed and extensive operation and it probably leads to less scarring although the operative time is more tedious . But the probability of finding the sperm is high. Although the studies have shown that it has not materialized into more live birth rates if you do Micro TESE compared to just open TESE, it leads to more sperm finding so more of a chance that we find sperm through this method. Obviously the expertise is not available everywhere and the patient’s side effect profile should technically be better if you do Micro TESE, but obviously it depends on the expertise of the operator as well.
The micro Tese is the most sophisticated approach of the known classic TESE. It involves the use of microscope as well by the urologist when she/he opens up one of the testicles or both testes and exiles a small amount of tissue which then the clinician will pass it onto Embryologist or Andrologist with the aim to find sperm.
