Understanding the Difference Between Conventional TESE and Microdissection TESE
Male infertility is a challenging issue faced by many couples trying to conceive. In cases where sperm retrieval is necessary for assisted reproductive technologies, surgical procedures like Testicular Sperm Extraction (TESE) become vital. Two main techniques used for TESE are conventional TESE (cTESE) and microdissection TESE (mTESE). Understanding the differences between these procedures and determining the appropriate one for each patient is crucial for successful sperm retrieval and improved chances of conception.
cTESE is one of the oldest and most widely used procedures for sperm retrieval in cases of non-obstructive azoospermia, a condition where sperm production is impaired in the testes. During cTESE, the surgeon makes a small incision in the scrotum and takes a tissue sample from the testis, searching for areas that may contain sperm. This technique does not provide a clear view of the testicular tissue, making it more challenging to locate viable sperm. As a result, multiple tissue samples from different parts of the testis may be necessary to increase the chances of finding sperm.
Some advantages of cTESE include the fact that it is a relatively simple procedure, requiring less specialized equipment, it is suitable for centers with limited resources and expertise in microdissection techniques and it can be performed when microdissection equipment is unavailable. On the other hand, there are some limitations to cTESE, including lower sperm retrieval rates compared to mTESE, an increased risk of testicular damage due to multiple tissue samplings and difficulty in identifying and extracting immotile or abnormal sperm.
mTESE (or micro-TESE) is a more advanced technique introduced to overcome the limitations of cTESE. This procedure involves the use of an operating microscope, which provides a magnified and detailed view of the testicular tissue. The surgeon can precisely identify areas with higher sperm concentrations, leading to a more targeted approach and minimal tissue damage.
The advantages of mTESE include higher sperm retrieval rates compared to conventional TESE, increasing the chances of finding viable sperm, reduced risk of testicular damage, as the procedure allows for a more targeted and precise extraction and it is suitable for patients with extremely low sperm production, as it can pinpoint even small pockets of sperm. Limitations include the fact that it requires specialized equipment and surgical expertise, it requires a longer operating time and higher cost compared to cTESE and it may not be feasible in centers with limited access to microdissection technology.
Choosing the appropriate procedure for sperm retrieval depends on several factors, including:
Medical History: The underlying cause of male infertility and the type of azoospermia (obstructive or non-obstructive) must be considered. mTESE is more suitable for non-obstructive azoospermia cases, while obstructive cases may benefit from conventional TESE or other less invasive techniques.
Sperm Production: If the patient has severely impaired sperm production, as observed in non-obstructive azoospermia, mTESE is often the preferred choice due to its higher success rates in locating viable sperm.
Expertise and Resources: The availability of specialized equipment and the surgeon's expertise play a crucial role in determining which procedure to use. Centers with experienced microdissection surgeons and adequate resources may opt for mTESE.
Cost: mTESE can be more expensive due to the specialized equipment and longer operating time. In some cases, cTESE may be chosen if cost is a significant concern.
Both cTESE and mTESE are valuable techniques for sperm retrieval in male infertility cases. cTESE is a simpler procedure but may have lower sperm retrieval rates and a higher risk of testicular damage; whereas mTESE offers higher success rates and lower testicular damage, but requires specialized equipment and surgical expertise. Expert urologists specialising in male infertility should educate patients on their options and selecting the most appropriate procedure for their diagnosis.
Source: Esteves S. 2022; Deruyver Y et al, 2014; Johns Hopkins Medicine
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