How are sperm looked for?
Through an incision in the scrotum, the testicle is brought out into the wound and opened along the equator with a wide incision in the tunica albuginea in order to examine the entire parenchyma under a microscope. The tubules containing spermatogenesis are larger and whiter than the “empty” ones - they are taken in small fragments, which the embryologist immediately examines; the search continues until both halves of the testicle are found or completely examined. The membrane is sutured with microsutures, the blood supply is preserved. Compared to a conventional biopsy, Micro-TESE removes 50 to 70 times less tissue with twice the success rate. Before surgery, genetic causes are excluded (AZFa/b deletions, for which the search is futile) and, if necessary, hormonal preparation is carried out.
When is sperm retrieval needed?
With azoospermia - the absence of sperm in the ejaculate - conception is possible through IVF-ICSI, for which sperm are obtained surgically. In the obstructive form (patency is impaired, spermatogenesis is preserved), they are aspirated from the epididymis (MESA) with a success rate of more than 95%. In the non-obstructive form (spermatogenesis itself is impaired), foci of preserved spermatogenesis are looked for under a microscope inside the testicle (Micro-TESE) - sperm are found in 40–60% of men, including those with Klinefelter syndrome and after chemotherapy.
Results and cryopreservation
The resulting sperm are either immediately used to fertilize the partner’s eggs (the operation is synchronized with follicle puncture), or are frozen in a cryobank for future IVF cycles. The embryologist evaluates the material directly in the operating room. Complications are rare: hematoma, temporary pain; testicular function after Micro-TESE is preserved thanks to gentle microsurgical techniques.
