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TESE
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Sperm harvesting is entirely different from a diagnostic testicular biopsy because, in this setting, the goal is not to identify what is happening in the testis but instead it is to find sperm. Only men with no sperm in their ejaculate (azoospermia) need to have sperm retrieved directly from the testis or epididymis. This may involve a simple aspiration for men who have a blockage or require much more extensive sampling of the testis for men who have a sperm production problem. As a result, there is a significant difference in the amount of time it takes, the need for anesthesia and the equipment utilized.

Very few tests allow for an accurate prediction of whether or not sperm will be found in the testes of men with testicular problems. Genetic testing may give insight into the chance of finding sperm but are not absolute. The pattern of the problem of the testis found at the time of a diagnostic testicular biopsy may be slightly predictive, but again there is no finding that absolutely predicts the presence or absence of sperm. Other blood tests, including hormonal studies, are not predictive.

Finally, even having sperm found on a previous harvesting session does not guarantee that sperm will be found on future harvesting attempts. Thus, diagnostic testicular biopsy is not routinely performed in patientswho are to undergo testicular harvesting of sperm when the cause of their zero sperm count is already established through other means.

Testicular sperm extraction (TESE)
TESE involves making a small incision in the testis and examining the tubules for the presence of sperm. It is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval. TESE is usually performed in the operating room with sedation, but can be performed in the office with local anesthesia alone. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. MicroTESE hasreplaced this as the optimal form of retrieval for men with no sperm in their ejaculate (azoospermia) from a problem with production.

Microdissection TESE (microTESE)
MicroTESE is a procedure performed for men who have a sperm production problem and are azoospermic. MicroTESE 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 there for the other’s procedure. Patients frequently have donor sperm backup in case sperm are not found in the male partner. MicroTESE has significantly improved sperm retrieval rates in azoospermic men, and is a safer procedure since less testicular tissue is removed. Patients cryopreserve sperm during this procedure for future IVF/ICSI.
 
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