What is MicroTESE?
(Micro Dissection- Testicular Sperm Extraction):
MicroTESE method is the most reliable biopsy method that has replaced all other techniques in recent years. Performing the biopsy procedure under a specially designed microscope makes this special. This allows for much better detection of possible sperm production centers. It is possible to find sperm with MicroTESE in patients when no sperm could be found with different biopsy methods before. In addition, since less tissue is taken in the microTESE method and the vessels feeding the testicles are not damaged, the recovery period of the patient shortens considerably.
Brussels IVF Unit has been applying the microTESE method for a very long time with a team specialized in this field.
What are the Methods of Obtaining Sperm from the Testis?
Where there is no sperm cell found in the man's ejaculate, a biopsy can be taken from the testicles by various methods. In our unit, doctors specialized in infertility urology decide which of these methods will be applied. The procedure takes about 1 hour under general anesthesia and the patient is discharged on the same day.
TESE (Testicular Sperm Extraction):
This is a biopsy method that is no longer preferred in units where microTESE method can be performed. By opening the testicles, much larger tissue particles are taken compared to MicroTESE, and sperm cells are searched for in them.
TESA (Testicular Sperm Aspiration):
This method is generally applied to men who have good sperm production but do not have sperm in their ejaculate due to blocked canals. This condition is called obstructive azoospermia. TESA is a method of obtaining sperm from testicular tissue by entering with a needle.
PESA (Percutaneous Epididymal Sperm Aspiration):
In the testis, sperm cells accumulate in the area called the epididymis. PESA is a method of obtaining sperm by entering the epididymis with a needle.
MESA (Micro-Epididymal Sperm Aspiration):
This is the method of finding sperm by entering the epididymis with a surgical operation instead of a needle, and removing tissue particles.
Sperm Production and Stages in Testicles:
Sperm obtained from the testicles by biopsy methods are called testicular sperm. Sperm production takes place in the seminiferous tubules. Seminiferous tubules consist of germ cell layers and canals called lumen in the middle.
Germ cells lay these canaliculi. Round immature sperm cells are located in the outer part, while mature spermatozoa are located in the lumen. Lumens unite and provide sperm flow to the epididymis. In men, the production of sperm in the seminiferous tubules is ensured by the effect of the FSH hormone secreted from the pituitary gland. LH hormone, on the other hand, controls testosterone production from Leydig cells and indirectly affects sperm production and maturation.
After completing certain division and maturation stages, germ cells proceed from the spermatogonium to the spermatozoa stage. While the chromosome number is 46,XY in spermatozonium, the chromosome number is halved in spermatozoa that are formed in the last stage as a result of meiosis divisions (23,X or 23,Y). This chain of events is called "Spermatogenesis".
Many enzymes and substances such as proteins play a role in every stage of spermatogenesis. Many factors are effective on spermatogenesis, mainly genetic and hormonal effects. A sperm cell must have reached the mature form, the spermatozoa (mature sperm) so that it can fertilize a female egg. ICSI cannot be performed using immature forms of sperm cells, which are stated as immature, or even if it is done (ICSI using spermatid), pregnancy rates are very low.
Sperm cells produced in the seminiferous tubules pass into the sperm-carrying ducts. They proceed through in order, as rete testis —› ductus deferens —› epididymis —› vas deferens —› ejaculatory duct —› the seminal vesicle. Sperm cells stored in the seminal vesicle are expelled as semen from the tip of the penis during ejaculation. Apart from the sperm cells, the liquids produced in the prostate and other glands are also mixed with the seminal content.
Sperm cells produced in the seminiferous tubule in the testis first proceed to the epididymis and then into the vas deferens canal. Occlusion in any area along this pathway leads to obstructive azoospermia. If the absence of sperm in the semen is due to the lack of production or less production than normal in the seminiferous tubules, this is called non-obstructive azoospermia.
Andrological examination of azoospermic men should be done very well. As a result of hormonal and genetic tests, the type and cause of azoospermia are tried to be understood.
In the case of advanced sperm deficiency and azoospermia, the following blood tests are performed:
Follicular stimulating hormone (FSH)
Luteinizing hormone (LH)
Y chromosome microdeletion