Micro TESE Operation

It is the most reliable biopsy method having been used instead of all other techniques in recent years. What makes this method special is that biopsy is performed under a specially designed microscope mechanism. This method enables determination of possible sperm production centers better. It is possible to find sperm with M. TESE in the patients with no sperms detected using different biopsy methods previously. Furthermore, as less tissue is taken and the vessels feeding testis aren’t damaged in TESE method, it shortens recovery period of the patient significantly.

In Brussels IVF Unit, M. TESE method has been applied for a long time by a specialist team.

What are the Methods to Obtain Sperms from Testis?

If ejaculate of a man doesn’t contain any sperm cell, biopsy can be taken from testis using various methods. Which method will be used in our unit is decided by our doctors who are specialized in the field of infertility urology. The operation lasts approximately 1 hour under general anesthesia and the patient is released from hospital on the same day.

TESE (Testicular Sperm Extraction):

It is a biopsy method not preferred in M. TESE units anymore. Testis is opened and bigger tissue particles are taken when compared to M. TESE and sperm cells are searched within these particles.

TESA (Testicular Sperm Aspiration):

It is generally applied to men who haven’t sperms in ejaculate due to blocked vessels although in spite of good sperm production. This situation is called obstructive azospermia. TESA is a method of obtaining sperm from testis tissue by inserting with a needle.

PESA (Percutaneous Epididymal Sperm Aspiration):

Within the testis, sperm cells accumulate in the region called epididym. PESA is a method of obtaining sperm by inserting into epididym with a needle.

MESA (Micro-Epididymal Sperm Aspiration):

It is a method of finding sperm taking tissue particles by entering into epididym not with a needle but through surgical operation.

Sperm Production in Testis and Its Stages:

The sperms obtained from testis through testis biopsy methods are called testicular sperms. Sperm production takes place in seminiferus tubulus. Seminifer tubulus is composed of germ cell layers and vessels called lumen in its center. Germ cells spread these vessels. While round immature sperm cells exist at external side, mature spermatozoa exist in the lumen. Lumens come together and ensure sperm flow to epididym. Effect of FSH hormone excreted from pituitary gland on man ensures sperm production in seminifer tubulus. LH hormone controls testosterone production from Leydig cells and shows an indirect effect on sperm production and maturation.

Germ cells complete certain stages of splitting and maturation and develop from the stage of spermatogonium to spermatozoa. While number of chromosomes in spermatozonium is 46, XY, the number of chromosomes in spermatozoa occurring at the final stage as a result of meiosis decreases half (23, X or 23, Y). This chain of events is called “Spermatogenesis”.

Many substances such as enzyme and protein play role at every stage of spermatogenesis. Many factors, especially genetic and hormonal effects, have impact on spermatogenesis. In order to fertilize a woman oocyte, a sperm should reach the stage of spermatozoa 8 which is the mature form. ICSI cannot be performed with immature forms of sperm cells or, even if it is performed (ICSI with spermatide), rates of pregnancy are very low.

The sperm cells produced in seminifer tubulus pass to the vessels carrying sperms. They advance through rete testis —› ductus deference —› epididym —› vas deference —› ejaculator ductus —› seminal vesicle in order. The sperm cells stored in seminal vesicle are thrown out through penis end as semen during ejaculation. The semen does also contain liquids produced by prostate and other glands other than sperm cells.

The sperm cells produced in seminifer tubulus within testis tissue advance firstly to epididym and then to vas deference. Obstruction at any region on this route leads to obstructive azoospermia. If there is no sperm in the semen and the reason is scarcity or lack of production in seminifer tubulus, it is called as non-obstructive azoospermia.

Andrologic examination of an azoospermic man should be performed very well. It should be tried to understand type and reason of azoospermia as a result of hormonal and genetic tests.

The following blood tests are performed in case of advanced scarcity of sperms and azoospermia:

Follicular stimulant hormone ( FSH )

Luteinizing hormone ( LH )

Testosterone ( T )

Prolactin (PRL)

Genetic research

Y Chromosome microdeletion

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