Male infertility refers to the inability of a man to contribute to conception or achieve pregnancy in a female partner. It can result from various factors that affect sperm production, quality, or transport. Here is a comprehensive overview of male infertility:

1. Causes of Male Infertility:

Low Sperm Count (Oligospermia): A reduced number of sperm in the ejaculate, making it less likely for one to reach and fertilize an egg.

Poor Sperm Motility (Astheno-spermia): Sperm with limited or sluggish movement, hindering their ability to swim toward the egg.

Abnormal Sperm Morphology (Terato-spermia): Sperm with irregular shapes or structures, which can affect their ability to penetrate an egg.

Obstruction: Blockages in the reproductive tract, preventing the release of sperm during ejaculation.

Hormonal Imbalances: Disruptions in hormonal signals can affect sperm production and maturation.

Genetic Factors: Inherited genetic conditions can lead to abnormal sperm development.

Testicular Issues: Conditions such as testicular trauma, infections, or surgery can impair sperm production.

Varicocele: The enlargement of veins in the scrotum can elevate testicular temperature and damage sperm.

2. Diagnosis:

Diagnosis of male infertility typically involves a comprehensive evaluation, including a medical history, physical examination, semen analysis, hormonal blood tests, and, in some cases, genetic testing.

3. Treatment Options:

Lifestyle Modifications: Adopting a healthier lifestyle by quitting smoking, moderating alcohol intake, maintaining a healthy weight, and managing stress can improve fertility.

Medications: Hormonal treatments, antibiotics for infections, or medications to address specific issues may be prescribed.

Surgical Interventions: Procedures like varicocelectomy can correct anatomical abnormalities or blockages in the reproductive tract.

Assisted Reproductive Technologies (ART): Techniques such as intrauterine insemination (IUI) or in vitro fertilization (IVF) can be used when natural conception is challenging.


(Percutaneous Epididymal Sperm Aspiration)

Percutaneous Epididymal Sperm Aspiration (PESA) is a process for retrieving sperm from the epididymis (a tube that connects a testicle to a vas deferenc in a male reproductive system). One of the advantages of PESA is effective that it can be performed without a surgical cut in the scrotum. It is a simple, quick, cost- technique and can be repeated easily.




(Testicular Sperm Aspiration) / (Testicular Sperm Extraction)

In TESA/TESE  or in Testicular Sperm Aspiration, a needle is inserted into the testicle, and tissue/sperm is aspirated. It is a procedure performed for men who are having sperm retrieved for IVF/ICSI.


(Micro-Epididymal Sperm Aspiration)

Micro-Epididymal Sperm Aspiration or MESA is performed for men with an epididymal obstruction, vasectomy, or congenital bilateral absence of the vas deferens. It is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval. MESA allows for an extensive collection of mature sperm compared to aspiration techniques.


What is MicroTESE?

MicroTESE or Microsurgical Testicular Sperm Extraction refers to a surgical procedure used to retrieve sperm from a male testis. It is considered as one of the most effective methods of sperm retrieval and is performed mainly in cases of severe infertility like azoospermia (inability to produce sperm). MicroTESE is carefully coordinated with the reproductive endocrinologist and performed at designated times on a quarterly basis.

When is it recommended?

MicroTESE is performed in men who are diagnosed with Non-Obstructive Azoospermia (NOA), which refers to a condition where the semen contains a negligible amount of sperm. It may occur either due to an intrinsic failure in the testis or inadequate production of hormones like gonadotropin, which are essential during the process of spermatogenesis (development of mature spermatozoa).

How does MicroTESE help with NOA?

Although the sperm count is zero or undetectable in NOA; however, in 60 percent of the cases, there may be minute areas within the testis that still produce the sperm. These tubules can be accessed with MicroTESE to retrieve a desired amount of sperm.

How is MicroTESE performed?

MicroTESE is a procedure performed for men who have a problem in sperm production and are azoospermic. This procedure is performed in the operating room with general anesthesia under the operating microscope. MicroTESE is carefully coordinated with the female partner’s egg retrieval and is performed the day before egg retrieval. This allows for each partner to be present during their partner’s procedure. MicroTESE has significantly improved sperm retrieval rates in azoospermic men and is a safer procedure since less testicular tissue is removed. The sperm retrieved during MicroTESE can also be cryopreserved for future IVF/ICSI.

MicroTESE is performed as an outpatient procedure (no overnight stay necessary) by a specialist like a urologist or an andrologist. It is carried out either under local or general anesthesia. A small incision, about 2-3 cm, is made in the middle of the testicle to gain access to the scrotal tissues. Following this, a surgical microscope with 40x magnification is placed over the operating field to search for and examine seminiferous tubules (which are a small network of tubes that contain sperm. The tubules which contain sperm are usually enlarged – these tubules are identified and extracted until a sufficient amount is collected. The collected sperm is then transferred for assisted fertility procedures or cryopreservation for later use. It is important to note here that MicroTESE is always performed along with ICSI or IntraCytoplasmic Sperm Injection, which is essentially when a single, viable sperm is injected directly into the egg.

What are the advantages of microTESE?

MicroTESE is widely accepted as a superior form of sperm retrieval compared to the conventional infertility treatments. Studies show that the sperm retrieved from micro TESE is usually of better quality in terms of sperm motility . The success rate with MicroTESE is very favorable – nearly 40-60% obtain great results from the procedure.

Some other advantages include:

  • Minimal pain and fast recovery post-surgery
  • Better chances of cryo-preservation of the sperm after retrieval
  • Fewer chronic changes to the scrotal tissues

Post-surgery care and recovery

Most men recover quite quickly following the MicroTESE procedure as the scrotal tissues heal comparatively faster. The Majority of patients experience minimal postoperative pain. However, your doctor may still prescribe some painkillers to ease your recovery period. Following the surgery, you may have to use a local ice pack for the next 24 hours to avoid any postoperative swelling or pain. It is also advisable to refrain from performing any strenuous physical activities up to 10 days post-surgery.

Are there any complications associated with MicroTESE?

MicroTESE is a minor surgical procedure with minimal complications. Most complications that arise post-MicroTESE can be treated conservatively. Some complications include hematoma, bleeding, or testicular damage.


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