Tarih:06.03.2017 Yazar:Ender Yalcinkaya Kalyan
Testicular sperm extraction; in other words TESE, is a surgical procedure providing us to evaluate whether there is a sperm production in the testicles or not. Well, there are certain criteria to decide to perform TESE operation; but what are these? Lets look over...
TESE is performed primarily to the men who have been diagnosed with azoospermia at the end of routine semen analysis. However, I recommend to have at least 3 semen analyses at different times in order to decide to perform TESE (it is very important to have these semen analyses reports from an authorized IVF center or andrology laboratory!). The patients with a diagnosis of azoospermia can have a child only if they undergo an IVF treatment. Pregnancy rates are almost high as for normoospermic men among these azospermic men whose sperm production was confirmed by TESE operation in the absence of any female factor. Today, mostly microTESE procedure that is performed under special microscopes is preferred. The operation can be performed under general or local anesthesia depending on the preference and health condition of the patient. Patients can admit to their own urologists or IVF centers for this operation. Urologists can perform this operation in any hospital or authorized clinic, but it would be better to perform within an IVF clinic because sperm cells (if present) can be frozen as soon as possible in the cryo unit of the center when needed. These frozen cells can be used during IVF treatment in the future.
Various IVF centers use different ways when couples having an etiology of azoospermia admit. While some centers plan TESE operation simultaneously with ovulation induction (in other words; they start follicle development simultanesously), some others first perform TESE, freeze the tissues if sprm cells are present, and prefer to start ovulation induction later. Today, TESE operation is generally planned as the first step since the medications for ovulation induction are very expensive and women would have used too much hormone if there is no sperm production. However; there are some exceptions about the case. For instance; embryologists should inform the patients with a diagnosis of cryptozoospermia (meaning that the presence of very limited number of spermatozoa that can only be detected after concentrating the sperm in the ejaculate and check under higher magnification) about a possibility that they may provide consecutive semen samples at the day of oocyte pick up instead of recommending TESE to them directly. In this type of patients, the chance of finding sperm cells at TESE can be highly low. Since sperm cells are produced at a very small foci in the testes of these patients, these limited number of spermatozoa can be lost during biopsy procedure or washing steps. Therefore; I recommend using ejakulate sperms (maybe getting serial ejaculations) as the first choice instead of TESE in these patients in my laboratory. If I can not find adequate number of spermatozoa in order to fertilize all oocytes, I can recommend TESE.
TESE can be recommended not only to azzospermic patients, it can also be offered to some exceptional cases. Then, what are these exceptional cases? In one of my previous essays, I have mentioned about sperm DNA fragmentation and its target population. Today, recommending TESE to the patients with a high ratio of sperm DNA fragmentation and to whom had previous failed IVF attempts can be an alternative treatment option. Under these conditions, performing microinjection with the spermatozoa from their source may provide a positive contribution to the treatment.
Today, TESE tissues can be frozen and stored for 5 years legally in our country. However, according to recent guidelines, men who want to keep their TESE samples stored for more than 3 months should have a report of their DNA fingerprinting in their files.
Please write me in case of further questions. Take care....