Working Hours
- Monday - Friday
09:00 - 19:00
Contact
Ask the Experts
TESE, TESA
Testicular sperm extraction (TESE) and TESA testicular sperm aspiration (TESA) are surgical interventions performed in men with azoospermia (azoospermia) with the aim of obtaining spermatozoa from testicular tissue that will later be used for in vitro fertilization.
TESA is also called “fine needle aspiration“ (FNA).
For the success of TESE/TESA, in addition to the surgical part, the work of the embryologist on finding and freezing the spermatozoa, as well as the subsequent fertilization with the ICSI method during the in vitro fertilization (IVF) process, is very important.
When is TESE/TESA performed?
TESA is performed in obstructive azoospermia, while TESE is performed in both obstructive and non-obstructive azoospermia.
- in patients in whom spermatozoa were not found on aspiration of the epididymis (PESA);
The success rate of TESE/TESA is about 20%-30% in patients with non-obstructive azoospermia and about 80-90% in men with obstructive azoospermia.
TESE/TESA procedure
- Before TESE/TESA, it is necessary to perform the following analyses:
- hormones FSH, LH, TSH, prolactin, testosterone;
- genetic analysis: karyotype and Y chromosome deletions (AZF a, AZF b, AZF c). It is also necessary to examine the female partner before deciding on performing TESA /TESA.
- The patient fills out a detailed questionnaire about his state of health.
- TESE/TESA can be performed under local or general anesthesia. TESA is often performed under local anesthesia, and TESE under general anesthesia.
- When it is done under general anesthesia, before the operation there is a conversation with a doctor specializing in anesthesiology and blood tests are done. If there is a disease or risk factor, it is necessary to perform additional analyses and an examination by a doctor of another specialty, most often an internist.
- The patient receives an antiseptic shampoo in Clinic, which he will use to shower the night before and the morning before the intervention.
- 6-8 hours before TESE/TESA, the patient stops taking food and liquids. If the patient uses aspirin or other anti-clotting drugs it is necessary to stop the therapy 7 days before the operation.
- Upon arrival, the patient goes to the patient room where he is prepared to enter the operating room. A needle is inserted into the vein so that the patient can receive the necessary medication.
- TESE/TESA is performed on the operating table. The patient receives an intravenous antibiotic immediately before surgery. The surgical field is treated with an antiseptic agent containing iodine or chlorine.
- TESA is performed by inserting a needle into the testicle after receiving local or general anesthesia and then applying negative pressure that pulls out a small part of the testicular tissue (seminiferous tubules).
- In the TESE procedure, after receiving local or general anesthesia, an incision of about 2-3 cm is made scrotal skin. Then an incision is made on the sheath of the testicle and the testicle is displaced from the scrotum. 3-4 small incisions of up to 5 mm are made on the white sheet of the testicles (tunica albuginea), from which testicular tissue is taken. The resulting tissue is immediately given to embryologists in the IVF laboratory. If a sufficient number of spermatozoa are found from one testicle, no intervention is performed on the other testicle. Small incisions on the testicle are sewn up with thin surgical suture.
- The sheeths of the testicles are sutured with a thin suture and the testicle is returned to its anatomical place. If spermatozoa are not immediately found in one testicle, the procedure is repeated on the other testicle. At the end of the procedure, the scrotum is closed with a self-resorbing thread, that is, the surgical thread does not have to be removed. One sample is taken from both one and the other testicle (if analyzed) for histopathological analysis to see if there is a process of spermatogenesis and to exclude possible malignant changes.
TESE/TESA takes 15-30 minutes. At the end of the procedure, the patient receives a local anesthetic to relieve pain after the intervention.
- TESE/TESA is performed as day surgery. The patient moves from the operating room to the patient room where he stays for up to 2 hours after the intervention. First, he gets water, and then a light meal.
- Pain is treated with painkillers, most often paracetamol, ibuprofen and diclofenac. Nausea and tiredness are sometimes felt during the day as a result of anesthesia. Swelling and often blue color of the skin are present several days after the operation, as well as discomfort, which can be described as a condition after a ball hit the testicles. The patient is not advised to drive a car on the day and several days after the intervention.
- Showering is allowed, but not sitting in the tub and swimming until the skin wound is completely healed. For the protective patch, it is removed from the wound after 5 days, and in the meantime, it is changed as needed.
- The patient can return to normal activities 4-5 days after the operation, depending on the work performed.
The patient receives information about the result, that is, whether spermatozoa were found, before going home. The obtained spermatozoa are either immediately used for in vitro fertilization, or they are frozen for a later in vitro fertilization procedure. The results of histopathological findings are obtained 7-10 days after the intervention.
The wound is washed at home exclusively with saline solution.
When can't TESE/TESA be done?
TESE/TESA is not done:
- when there is a deletion of the Y chromosome AZF a and AZF b;
- after several failed TESE/TESA – individual assessment.
Complications during and after TESE/TESA
Complications during and after TESE/TESA are rare and may include:
- wound infection;
- infection of the epididymis;
- bleeding during and after surgery. Bleeding after surgery leads to the formation of a hematoma (clotted blood), more often in the scrotum than in the testicle itself;
- permanent drop in testosterone (very rare).
Expert advice: frequently asked questions
Answers by: Milan Milenković MD, PhD
What is the difference between TESE/TESA and micro TESE?
Micro TESE is an operation that is performed under the control of an operating microscope with a magnification of up to 24 times. The testis is completely opened (like a book) and then the tissue that meets the criteria for spermatogenesis is isolated with micro-instruments.
Micro TESE is performed in non-obstructive azoospermia and after unsuccessful attempts of TESE /TESA in obstructive and non-obstructive azoospermia.
TESE and TESA are "blind" testicular biopsies. In these methods, a random sample of tissue is taken and then analyzed in the IVF laboratory. TESE is an abbreviation of testicular sperm extraction, when a biopsy is taken with a special instrument or the testicle is "taken out" from the scrotum and several small incisions of 3-4 mm are made from which testicular tissue is removed.
TESA is short for testicular sperm aspiration, when the seminal ducts are removed from the testicles with a needle and analyzed in the IVF laboratory. The term “fine needle aspiration (FNA)" is also used. The success rate of TESE/TESA is about 20-30% in non-obstructive azoospermia.
How successful is TESE /TESA?
The success rate of TESE/TESA is about 20-30% in men with non-obstructive azoospermia and about 70-80% in patients with obstructive azoospermia.
Is TESE/TESA a painful intervention?
TESE/TESA is most often performed under general anesthesia so that the patient does not feel pain during the operation.
When it is done under local anesthesia, the patient may have an unpleasant feeling, that he feels that something is being done, but he does not feel pain. Local anesthesia is added during the operation, and the patient also receives intravenous pain medication. In the case when it is done under general anesthesia, the patient does not feel pain during the intervention.
A local anesthetic is injected into the skin of the scrotum and after intervention under general anesthesia to reduce pain in the first post-operative hours.
Mild pain may occur after TESE/TESA. Pain after surgery responds well to paracetamol, ibuprofen and diclofenac. Patients are advised to take Paracetamol, tablets 500 mg, 2 tablets up to 4 times a day for the first 3-4 days after surgery.
Can TESE/TESA be repeated?
TESE/TESA can be repeated if spermatozoa were isolated at the first operation. TESE/TESA can be repeated even when no spermatozoa were isolated during the first procedure, but in that case micro TESE is recommended.
When can in vitro fertilization (IVF) be done after TESE/TESA?
If the spermatozoa isolated during TESE/TESA are frozen, stimulation of the female partner for IVF can be started after the first menstrual cycle or later in agreement with the couple. When "fresh" spermatozoa are used, egg cells aspiration is performed on the same day as TESE/TESA.
Is it better to do in vitro fertilization (IVF) with frozen or "fresh" spermatozoa?
The percentage of pregnancies after IVF is similar when using frozen and “fresh" spermatozoa. The advantage of IVF with frozen spermatozoa is that there is no hormonal stimulation of the female partner unless the spermatozoa are isolated. If the woman already has frozen egg cells, IVF is done with "fresh" spermatozoa, and spermatozoa that are not used are frozen. With the TESA method, there is usually no material to freeze. TESA is not performed in non-obstructive azoospermia.
What is the cost of TESA/TESE surgery?
For all the prices of examinations and interventions in the Milenković Clinic, see our price list which is updated regularly.
When can I shower after TESE/TESA?
You can shower the same day after TESE/TESA, but bathing in the tub and swimming are not recommended until the skin wound has healed. It needs to be changed for a protective patch if it gets wet. It is not recommended to use soap or shampoo in the wound area until the skin wound has healed.
When can I train after TESE/TESA?
You can start training when you feel that you can train. It is most common 7-10 days after TESE, and 2-3 days after TESA.
When can I have sexual intercourse after TESE/TESA?
You can have sexual intercourses when you feel you can. It is most common 7-10 days after TESE and 3-4 days after TESA.
When is the first check-up after TESE/TESA?
Check-up after TESE/TESA is most often after 3-4 weeks or as needed. The patient is advised to first contact the surgery at 069 50 22222 or info@drmilenkovic.com for everything related to the operation.
In which acute situations should the Clinic be contacted?
In case of pain, high fever, swelling that increases and has a blue color, you should call 069 50 22222, or send a message to info@drmilenkovic.com.
What medicines should be taken in case of pain after TESE/TESA?
After TESA/TESA, discomfort in the testicle area is most often accompanied by mild pain. discomforts are more pronounced after TESE. Sometimes pain in the lower abdomen may also occur. Pain after the TESE/TESA procedure can be alleviated with a combination of analgesics and non-steroidal anti-inflammatory drugs. After the intervention, we will recommend the appropriate therapy according to your general state of health and level of discomfort.
Do hormone therapy and supplements increase the success of TESE/TESA?
There is no pre-TESE/TESA therapy that can increase success.
Supplements and vitamins have no effect on spermatogenesis and are not advised before TESE/TESA.
When can micro TESE be done after failed TESA/TESE?
Micro TESE as well as TESE/TESA can be done 3 months after the previous procedure.
Does varicocele surgery increase the success of TESA?
Varicocele, that is, dilated veins around the testicles, occurs in 5-10% of patients with non-obstructive azoospermia. About 10% of patients have spermatozoa in the ejaculate after varicocele surgery that can be used for in vitro fertilization.
Are there factors that can predict the success of TESE /TESA?
There are no parameters that can predict the success of TESE /TESA. Hormone values and testicle size before TESE/TESA cannot predict the outcome of the procedure
How long does TESE/TESA last?
TESE takes about 30 minutes, while TESA takes about 15 minutes.
