Nonobstructive azoospermia (NOA) is a male infertility condition characterized by an absence of sperm in the semen due to severely impaired or absent sperm production. This condition affects approximately 1% of the male population and 15% of men who seek fertility evaluation. For these men, the journey to biological fatherhood can be challenging, but advancements in assisted reproductive technologies, particularly Microscopic Testicular Sperm Extraction (Micro-TESE), have opened new possibilities for treatment.

What is Micro-TESE?

Micro-TESE is a medical procedure developed to help men with NOA. This procedure aims at retrieving sperm directly from the testicular tissue for use in assisted reproductive technologies, such as In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI).

The procedure involves the use of an operating microscope to identify areas of sperm production within the testes. The identified tubules are then removed and examined for the presence of sperm. Micro-TESE has revolutionized the treatment of male infertility, particularly in men with NOA, by significantly increasing the success rates of obtaining sperm.

What if the First Micro-TESE Fails?

The emotional impact of a failed Micro-TESE on patients can be profound. Infertility often carries a significant emotional burden, including feelings of guilt, shame, and inadequacy. The failure of a procedure like Micro-TESE, which may have been seen as a last resort, can exacerbate these feelings and lead to symptoms of anxiety and depression.

But a failed first attempt does not necessarily rule out future successful attempts or other fertility options. This is where a second Micro-TESE, often referred to as a salvage Micro-TESE, comes into play.

The Second Micro-TESE: A Salvage Procedure

The second Micro-TESE is a follow-up procedure performed when the initial Micro-TESE fails to retrieve viable sperm. The primary difference from the first procedure lies in the circumstances and expectations. As a salvage procedure, the second Micro-TESE is performed with the knowledge that the initial attempt was unsuccessful. This may influence the surgical approach, with the surgeon being more exhaustive in searching for sperm-producing tubules.

Despite its potential, the success of a second Micro-TESE is not guaranteed and depends on various factors including age, presence of conditions like Klinefelter's syndrome and varicocele, cryptorchidism, mean testicular volume, and hormonal profile.

Efficacy of Second Micro-TESE

The efficacy of the second Micro-TESE has been investigated in several studies. For instance, a study published in the Haseki Training and Research Hospital journal reported that the sperm retrieval rate in patients who underwent salvage Micro-TESE was 36.99% (27 out of 73 patients).

Another study conducted by the Department of Urology, The Fourth Affiliated Hospital of Harbin Medical University, observed that several factors could potentially determine the success of salvage Micro-TESE. These findings suggest that while the success is not guaranteed, a second Micro-TESE can potentially result in successful sperm retrieval in some cases.

Emotional Impact and Support

In case of another failure, the emotional impact on the patient can be significant, potentially leading to feelings of disappointment, stress, and anxiety. It's important for healthcare providers to provide emotional support and discuss alternative fertility options if the second Micro-TESE does not yield successful results. As part of our commitment to supporting our community, we are pleased to announce that Lorra Kapteyn, a renowned male fertility therapist, is offers support and guidance to the Fertiliti community. Lorra's expertise can be accessed through our "Ask me Anything Forum." Click here to seek invaluable support from Lorra and take a step towards a brighter fertility journey. You're not alone on this path.

In conclusion, a second Micro-TESE is a crucial procedure that offers a chance at biological parenthood to men with nonobstructive azoospermia. It's important for patients to understand the potential outcomes, risks, and benefits of the procedure. Emotional support and a discussion about potential alternatives are crucial to help patients navigate the potential outcomes of this challenging journey.

Reference : A. Tsujimura, Y. Miyagawa, T. Takao, S. Takada, M. Koga, M. Takeyama, et al.

Salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction in patients with nonobstructive azoospermia

J Urol, 175 (2006), pp. 1446-1449