Are there any other reasons to perform TESE?

When ICSI or micro injection was used and successfully used, this revolutionized the treatment of male infertility and from there on (which was back in 1992) the more and more techniques have been coming into adding benefit to treatment of medical male related factor, for example, we can use a sperm that is retrieved from the testicles directly – TESA or TESE, this can actually help not only with the male factor that has very low sperm or is azoospermic due to blockage in the testicles but, in some cases, it can actually help if we are seeing a high DNA fragmentation in the sperm. This can happen, this DNA fragmentation can increase in rate as the sperm passes through the tubules and therefore for us to go further up and collect the sperm from further up into testicles, it could help to retrieve sperm that is less DNA fragmented and can help us with the fertilization and survival of embryos and implantation rates.

TESE can be done for men who would follow two different categories so you have obstructive azoospermia so that’s no sperm in the ejaculate and obstruction can be because of something like cystic fibrosis and the testicles have no way of getting the sperm out into the ejaculate or they’ve had vasectomy and it’s just a case of doing a PESA where needles placed into the epididymis and aspirated. Generally it’s quite straightforward, they’re very easy to do. You can have non-obstructive azoospermia which is more difficult to get sperm from, so that could be to do something with a hormonal problem so if you’re FSH which is what causes your testicles to produce sperm, if that’s quite high, it can actually shut your testicles off and from producing sperm – so there’s no sperm in your ejaculate and the higher the FSH gets, the less chance of finding sperm

Are there any other reasons to perform TESE? Yes, there are. Currently we may give this option to a male, infertile male that suffers from oligospermia linked to a high DNA fragmentation index. There are data that confirms that a testicular biopsy for non-azoospermic males with affected DNA fragmentation, may provide them a benefit as the testicular spermatozoa seems to perform better over the ejaculated spermatozoa in these cases in terms of embryological outcomes and clinical outcomes.

The classic indication is that there’s no sperm in the semen so the couple can’t go forwards with IVF or ICSI treatment but sometimes, it can be performed if, for example, the sperm is all immotile. Occasionally we find that you might get motile sperm in some men by getting it from the testicle directly. Sometimes, you get a situation where the man can’t produce a semen sample on the day of egg retrieval and in those sort of cases which are infrequent as an alternative to canceling the treatment or freezing the eggs after going over the egg retrieval, you can do a sperm retrieval but obviously in that situation, the couple would be then having to have ICSI treatment rather than IVF and execute at least has more kind of theoretical risks so, it’s perhaps to be avoided if possible. Those are kind of the main indications really other than the conventional azoospermia.

In our patients’ cases and from our 10 years of experience, 80 % of the DNA fragmented or low count because most of the low count spermatozoa from the husband usually showed a vast number of spermatozoa which means the fragmented material would be high. Then there are some multifactorial treatments where we use multivitamins and some other natural products for the cure and we’ve seen so far that the outcome of 80% of the sperm can be cured. That is a high percentage but the 20% is not cured, so we suggest immediately the technique of TESE. That means, they inject from the testicles genetic material – sperm and then they culture this and from the bibliography and the references that we have read many so far, we see a decrease of the DNA fragmentation and much quality of of the spermatozoa from about 15 to 20 % and all this recorded in in the international journals that the technic TESE when I have a problem with the DNA fragmented material, can help to decrease the DNA fragmentation and help the outcome of the IVF trial.

When we are doing it TESE it can be primarily for two main reasons: it would be in patients with what we call a non-obstructive azoospermia or an obstructive azoospermia.
We have seen also recently cases where patients they want to improve the life-birth rate so they had IVF before but they had poor outcome from that cycle so we have seen that more and more people are asking for the extraction of testicular sperm and that’s been to be used for the egg insemination although most of them men are non azoospermic which is still quite a controversial issue but it’s something also we have seen in the clinics at least across Europe today.
As I said it would be primarily men with where we don’t see sperm on the ejaculate and that would be because there is an obstruction on the air circulatory ducts and that is because and also in azoospermic men where there’s not an obstruction but there can be other reasons for not finding sperm on the ejaculate. That would be the primarily two main reasons but as I said there might be a cases where couples they’re trying to find to increase the chances to improve the outcomes of their IVF and they have been talking to professionals and exploring their options of using testicular sperm as well.
I’ve mentioned it is still a controversial issue and we don’t have robust data to show us that using testicular sperm it necessarily improves the embryo quality and also the the results of the life-birth after the ART technique.