How successful is TESE procedure?

The success of TESE depends on how much sperm we actually manage to retrieve and whether those sperm are alive, moving and normal so, these are the three very important factors that we look at from the sperm that is that we get obtained from TESE and of course, when we freeze it, will the TESE thaw well and survive the process of freezing and thawing. So a lot of times patients may go through an ICSI treatment with a fresh TESE sperm or they may have had to have it done previously and freeze the sample. What we do in the lab is when we freeze any TESE sample we will do a small thaw the next day just to see how well the sperm survives the freezing procedure. So, the whole success will depend on will we have live sperm, will we have a sperm that at least is motile to some extent and do we have normal looking sperm.

Well TESE is used for men who don’t have sperm and their ejaculate and it’s their only way of having their own biological child. It will always vary patient to patient on their clinical history about how successful and what their chances of success of getting that sperm will be. Once we’ve got the sperm, in most cases, the fertilization rate may be slightly lower but in most cases, it’s the same and then once we’ve covered that fertilization hurdle, the success rates are fairly identical – at least in our lab and it’s just crossing that first hurdle of one getting the sperm and secondly then getting the fertilization after that – this shouldn’t be really any difference and but for those men where we don’t get any sperm, then it’s donor’s sperm.

TESE which it’s an operation, a surgical retrieval of testicular tissue pieces from the testicles. It normally works well for azoospermic men that have been diagnosed with obstructive azoospermia where the region of azoospermia is due to the presence of obstruction and the level of spermatogenesis is high and comparable to normal. So, in these cases, we may aim for 100% of sperm retrieval rate. However, when it comes to non-obstructive azoospermic men, where the we have a diminished spermatogenesis and no presence of an obstacle, then the sperm retrieval rate is much lower. It has been estimated that for this category of azoospermic men, we may have at 40 to 50% of sperm retrieval rate so, the success rate after IVF after TESE will depend on the number of spermatozoa retrieved and the quality of spermatozoa we have for the patients. So while in TESA normally it mostly involves couples that suffer from obstructive azoospermia which means that in most of these cases we will have good quality and high performing spermatozoa so, for these people, for these patients, the success rates are quite high in terms at least from the paternal factor. Testicular sperm performance always depends on the female factor as well.

The chance of success really depends on the underlying problem. If it’s a production type problem like the man’s had a vasectomy in the past, any of these procedures had an excellent chance of recovering sperm as long as there’s no underlying fertility problem out with the vasectomy. Obviously you need to bear that in mind because the men could be a bit older in some cases and could have health issues since the original family that they formed. If it’s a production type problem though, then it does vary a bit. If there’s a situation where sperm isn’t being made, it may have been made at all, procedures like micro TESE you have a roughly 50% chance of recovering sperm. Less invasive procedures would be much less successful at producing sperm for fertility treatment.

The success rate can be variable depending on the clinical case that we are dealing with and also in case if it is obstructive azoospermia or non-obstructive azoospermia. In most cases with obstructive azoospermia in male, we have a high success rate – more than 70-80% because we know the reason for the azoospermia is because there is an obstruction usually in the ejaculatory ducts. If we are doing procedure in case of non-obstructive azoospermia which means that there are other factors causing it like high FSH or the patient have non descending testicle in young age, then I would be very cautious when I give the number but I would expect the success being around 50%. This also depend on genetic background of the patient, TESE may become way challenging, for example, one of the most challenging TESE cases that we have seen so far will be the Klinefelter syndrome patients when we expects low amount of sperm to be found after TESE and to make isolation and the storage of the spermatozoa quite challenging in the lab as well. I would say that the success rate in that patients not greater than 10-20%