If there is no ejaculate, if there is no sperm in the ejaculate ( azoospermia) or if there are few sperms ( oligoastenozoospermia) , micro TESE procedure is done with the help of a microscope to get sperm out of the testicles.
Micro TESE can be done by general or local anesthesia. 4 cm incision is done in the scrotum, and the testicle is removed outside of the scrotum. Layers, which possibly contain sperms, are searched and small units are taken out while zooming into the layers by 15-20 fold compared to the human eye. If there is no sperm found then the other testicle is searched. After the procedure, the incision is closed with an absorbable suture. The patient is discharged the same day after the procedure.
There are 2 approaches in this situation. Either with Frozen Sperm or with Fresh Sperm
If the Micro TESE would be done on the day of the egg collection of the woman via IVF, then found fresh sperm can be used directly which is preferred. But if there won’t be any available sperm, then the woman would end up with no sperm injection, which is a risk for the couple both emotionally and financially.
In the second option, we first do the micro TESE and freeze the sperms immediately. The next day, we begin with the IVF process of the woman ( cycle day 2 or 3). Egg collection happens around cycle day 14, the same day we implant the frozen sperms to the collected eggs ( ICSI).