Introduction

Welcome to your journey towards parenthood! You've made the important decision to undergo a microscopic testicular sperm extraction (microTESE), a procedure that holds the promise of fulfilling your dreams of having a family. In this guide, we will walk you through the intricacies of the microTESE surgery, what to expect during your hospital stay, and the steps to follow once you return home.

Why Choose microTESE?

Microscopic testicular sperm extraction (microTESE) is a specialized procedure designed for men who face challenges with sperm production and are diagnosed as azoospermic, meaning there is no sperm present in their ejaculate. While similar to standard testicular sperm extraction (TESE), microTESE is a more complex procedure that takes place in an operating room under general anesthesia. The critical distinction lies in the use of a surgical microscope to pinpoint seminiferous tubules within the testicles that are more likely to contain viable sperm. Multiple tubule samples are extracted from each testicle and carefully evaluated by an andrologist, using a powerful benchtop microscope, to identify the presence of sperm. The process continues until a sufficient amount of tissue is obtained for use in assisted reproduction techniques. Any extra sperm collected can be cryopreserved for future IVF/ICSI cycles. The likelihood of finding sperm through microTESE is approximately 50%.

The Surgical Procedure

The microTESE surgery involves creating an incision on the front of the scrotum, exposing the testicle, and opening its outer tunical layer. The testicle is then carefully bivalved, with utmost care to preserve the integrity of the seminiferous tubules and arteries. A surgical operating microscope aids in identifying healthy-looking tubules where sperm is more likely to be found. Multiple samples of these tubules are extracted, and a trained andrology specialist assesses them in real-time within the operating room for the presence of sperm. If sperm is located, it is collected for use in IVF with ICSI. If no sperm is found in one testicle, the procedure is repeated on the opposite side.

Before Surgery

Prior to your microTESE surgery, you may undergo a pre-operative evaluation, which includes a physical examination, chest X-ray, blood and urine tests, an electrocardiogram, and other necessary assessments for your health and safety based on your Doctor’s advise. During this evaluation, you'll receive guidance on medications to take and those to avoid before surgery. Medications such as blood thinners, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be reported to your doctor and discontinued at least a week before surgery to ensure your safety. The day before surgery, you can have a light breakfast but must begin consuming clear liquids only and refrain from eating or drinking after midnight.

The Day of Surgery

During surgery, at least one family member should be present in the Hospital throughout the surgery to receive updates from your doctor.

The surgery itself typically lasts 2-3 hours, with additional time required for preparation before and recovery afterward.After the surgery, you'll transition to a recovery area. When you wake up, the hospital staff may offer you a light meal or beverage. On the same day, it's crucial to have a family member accompany you for the journey back home.

After Surgery: Home Care Instructions

Once you return home after your microTESE surgery, it's essential to follow these care instructions for a smooth recovery:

• Apply an ice pack for 20 minutes every hour for the first 24 hours to reduce swelling and alleviate pain.

• Wear snug underwear or an athletic supporter for at least one week to provide additional support.

• Start daily showers 48 hours post-surgery and ensure the area is thoroughly dried.

• Avoid strenuous physical activities until your post-operative checkup at two weeks.

• Take prescribed pain medication as needed and antibiotics as directed.

• You can use ibuprofen or naproxen for mild to moderate pain as prescribed by your doctor.

• Continue any fertility medications you were taking before the surgery.

• If you're on blood thinners, consult with your healthcare provider before resuming these medications.

Recovery Following Surgery

During your recovery, please adhere to the following recommendations:

• Take medications as prescribed for pain and antibiotics.

• Swelling and bruising in the scrotal area are common but should subside.

• Do not submerge your incision in water until it has fully healed (at least one week).

• You may shower 48 hours post-surgery and allow warm, soapy water to run over the area. Pat the area dry with a towel.

• The incision is closed with dissolvable stitches under the skin and medical super glue on the skin. Do not pull or tug at the stitches or glue.

• Supportive underwear enhances comfort and reduces scrotal discomfort.

• Ice packs can be used as needed every 20 minutes in the first few days to minimize swelling and discomfort.

• Refrain from lifting anything heavier than 10 pounds for the first 2 weeks.

• Abstain from all sexual activity, including masturbation, until your postoperative follow-up.

Your Follow-up Visit

Approximately two weeks after your microTESE surgery, you will have a follow-up appointment with your surgeon. During this visit, your incision site will be checked, and your recovery progress will be reviewed.

When to Contact Your Healthcare Provider

Contact your doctor if you experience any of the following:

• Difficulty urinating or inability to urinate.

• Fever of 102 degrees Fahrenheit or higher.

• Pain that worsens or does not improve with medication.

• Uncontrolled nausea and vomiting.

• Pain or swelling in your legs.

• Chills and body shakes.

• Active bleeding, increased redness or drainage, or unusual swelling in the incision area.

• Any allergic reaction to prescribed medications.

Personalized Instructions

Your microTESE journey is unique to you, and your healthcare team will provide personalized instructions and support as needed.

We wish you a successful surgery and a swift recovery on your path to building your family.

[Disclaimer: This blog provides general information and should not be considered a substitute for professional medical advice. Consult your healthcare provider for specific guidance related to your situation.]