TESE/TESA/mTESE testicular sperm collection
A testicular biopsy is performed in patients diagnosed with azoospermia, i.e. a lack of spermatozoa, in the basic semen test – the semen profile. This procedure allows sperm to be extracted directly from the testicle.
A testicular biopsy is performed in patients diagnosed with azoospermia, i.e. a lack of spermatozoa, in the basic semen test – the semen profile. This procedure allows sperm to be extracted directly from the testicle.
What is a testicular biopsy?
What is a testicular biopsy?
In patients presenting with azoospermia, it is possible to obtain spermatozoa by epididymal or testicular puncture and then use these for in vitro fertilisation. However, this involves an additional procedure which, according to indications, may consist of either testicular sperm aspiration (TESA), testicular sperm extraction (TESE) or microsurgical testicular sperm extraction (mTESE).
MicroTESE is the most advanced approach and involves biopsying the testicle under powerful magnification with a surgical microscope. This lets the physician visualise the seminal tubules and locate areas where there is even minor sperm production.
The biopsy procedure provides information on whether sperm production takes place in the seminal tubules of the testis and thus whether it might be viable to use the extracted material in an ICSI-assisted insemination procedure.
Diagnosing the problem
Required testing
Female partner
Female partner
Male partner
Male partner
The TESE/TESA/MTESE testicular biopsy procedure is performed under general anaesthesia.
Treatment
Course of procedure
Stage I
Patient preparation
The patient is informed of the preparation plan by the attending physician and the medical staff.
Stage II
Procedure
Access to the testicle is gained by making an incision in the scrotal sac. The operator then searches for potential sperm production sites in the testicular seminal tubules and collects it. The procedure is performed under general anaesthesia.
Stage III
Freezing of testicular biopsy sample
Small fragments of tissue are collected in the course of the procedure. Embryologists analyse the collected tissue to find spermatozoa candidates for fertilisation of the ovum by micro-injecting a spermatozoon into an egg cell (ICSI) during in vitro fertilisation. They can either use spermatozoa immediately to fertilise female oocytes or freeze them for future use.
Good to know
All you should know
about this method
The testicular biopsy procedure is performed in patients who have had a semen test showing an abnormally low or absent sperm count (azoospermia), or when the results of other tests (blood analysis, determination of hormone levels) do not allow a specific cause of infertility to be found.
The testicular tissue collection procedure may help, for example, in detecting an obstruction of the vas deferens; in such cases, the testicles do produce spermatozoa, but these do not enter the semen and fertilisation does not ensue. A testicular biopsy is also performed to retrieve material for sperm fertilisation in patients who have previously undergone a vasectomy procedure.
A testicular biopsy is also ordered when testicular cancer is suspected, and to collect spermatozoa for insemination or in vitro fertilisation. The resulting biological material may be used immediately for in vitro fertilisation (ICSI) or frozen. A testicular biopsy is also one of the procedures for fertility preservation: oncofertility.
A testicular biopsy is advised in patients diagnosed with:
- Azoospermia;
- Primary testicular insufficiency;
- Congenital absence of vas deferens;
- Complete necrozoospermia;
- Failed vas deferens reconstruction after vasectomy.
The testicular biopsy procedure is performed under general anaesthesia.
A testicular biopsy is a minor surgical procedure involving the collection of small fragments of testicular tissue; afterwards, the tissue material is analysed for presence of spermatozoa.
The testicular biopsy procedure may not be performed if inflammation is diagnosed within:
- Testes;
- Epididymis;
- Scrotal sac.
Seven days before surgery, you should take the following blood tests for the purposes of anaesthesia:
- APTT, PT, sodium, potassium, and blood count;
- Have a blood type result (the result is valid for life);
- Report for the surgery 30 minutes earlier to complete documents and prepare for the procedure;
- On the day of surgery, your stomach should be empty, please refrain from eating and drinking (including water), and smoking for 6-8 hours before the surgery. Please remember to keep hydrated the day before the procedure;
- Shave the body part that will be operated on and your right leg from groin to knee;
- Wear comfortable clothes, such as T-shirt, sweatpants or other loose pants, zipped sweatshirt;
- Have with you still water and light snacks (e.g. sandwiches, sweet buns, yoghurt);
- After the procedure, you will stay in the clinic for 2-6 hours (depending on the anaesthesiologist’s decision); afterwards, you will be allowed to go home;
- Due to the administered medication, the patient must not leave the clinic alone; a trusted person (family or friends) must be asked to pick him up from the clinic.
More about this procedure
Testicular biopsy – types
TESE method
Open testicular biopsy (TESE) – by testicular sperm extraction. The procedure consists of precisely incising the testicular sheath and collecting a specimen from the epididymis and various regions of the testicle to increase the chance of finding sperm to use for in vitro fertilisation.
TESA method
Aspiration testicular biopsy (TESA) – by testicular sperm aspiration. A closed biopsy is a procedure that is done when the chance of sperm retrieval is very high. A closed biopsy is performed by puncturing the testis with a needle through the skin.
mTESE method
Microscope-guided open testicular biopsy (mTESE) by microsurgical testicular sperm extraction. MicroTESE is the most advanced approach and involves biopsying the testicle under powerful magnification with a surgical microscope. This lets the physician visualise the seminal tubules and locate areas where there is even minor sperm production.
Testicular biopsy procedure – success rate
Testicular biopsy procedure – success rate
Up to 80%
of men diagnosed with azoospermia have testicular foci of sperm production (spermatogenesis). The testicular biopsy procedure allows for extracting them and using them for in vitro fertilisation with success.
Procedure price list
| TESA (testicular sperm aspiration) – incl. freezing of testicular biopsy sample and its storage for 1 year (price excl. anaesthesia) |
PLN 2 800 |
| TESE (testicular sperm extraction) – incl. freezing of testicular biopsy sample and its storage for 1 year (price excl. anaesthesia) |
PLN 4 500 |
| mTESE (microsurgical testicular sperm extraction) – incl. freezing of testicular biopsy sample and its storage for 1 year (price excl. anaesthesia) |
PLN 10 500 |
| Anaesthesia for surgery, anaesthetic consultation, post-operative anaesthetic care |
PLN 750 |
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