In order to perform the IVF treatment applied by couples who cannot have a baby naturally, the reproductive cells of the man and the woman must first be present. In other words, if sperm and egg cells cannot be obtained, it is not possible to apply IVF treatment. Because in this treatment, pregnancy is achieved by using the own reproductive cells of the mother-to-be and father-to-be. In IVF treatment, the egg of the mother-to-be and the sperm of the father-to-be are taken out of the body, fertilization is performed in the laboratory environment and 1-2 of the healthiest embryos are transferred to the uterus.
In the case of Azoospermia (no sperm in the semen), which is one of the causes of infertility in the man, sperm is tried to be taken from the man by surgical methods in order to perform in vitro fertilization treatment. Ways for men who do not have sperm in their semen to obtain sperm from the testicles are; Tese, Tesa, Pesa, Mesa. Which of these methods will be used is decided after the situation evaluation of the IVF specialist and the urologist. However, it is possible to say that the most successful method used in today’s medical technology to obtain sperm from azoospermic men is micro tese (microscopic testicular sperm extraction).
What is TESE, how is it performed?
TESE is the removal of sperm by biopsy method by opening the testicles under local anesthesia in men who do not have sperm in their semen. In general, azoospermia is divided into two as obstructive and non-obstructive. In almost all cases of azoospermia, which is obstructive, sperm is obtained from the testicles by TESE method. However, in non-obstructive azoospermia, the rate of sperm retrieval by TESE method is about 50%. In cases where a large number of sperm are obtained by the TESE method, the necessary ones are used, other sperms can be frozen for use in subsequent microinjection methods.
What is TESA, how is it performed?
In men whose sperm production is within normal values, but no sperm are found in their semen, the reason is usually the obstruction of the sperm channels or the lack of sperm channels. In such cases, MESA, which is a surgical operation, TESA or PESA, which is sperm retrieval with an injection, and TESE, which is a method of retrieving sperm from the testicle by biopsy, is used if there is a defect in the testicle. Fertilization can be easily performed with sperms obtained with any of these methods. These procedures, which are performed under local anesthesia, do not harm the general health or sexual functions of the man. It is worth underlining that Micro TESE is the most modern and trouble-free method among the techniques performed in azoospermia cases today.
What is MESA, how is it performed?
The appendix organ behind and along the testicle, which consists of thin and microscopic tubes that are densely entwined in the back of the testicles, is called the Epididymis. The man’s sperm also mature and gain the ability to move as they move along this Epididymis. In MESA, which is one of the methods of sperm retrieval in men who do not have any sperm in their semen, the epididymis is entered by surgical operation and tissue fragments are taken from here to obtain sperm.
What is PESA, how is it performed?
The method of obtaining sperm by entering the epididymis, where sperm cells accumulate, mature and gain the ability to move, with an injection is called PESA.
How is Micro TESE performed?
Micro-TESE application is almost the most successful of the biopsy methods with a long history. With a specially designed microscope mechanism, sperm production centers can be detected very clearly and sperm can be found even in men who cannot obtain sperm with different biopsy practice. However, in the Micro TESE method, the patient recovers in a much shorter time because much less tissue is taken than the others and the vessels feeding the testicles are damaged much less. In men who do not have sperm in their semen because the sperm channels are blocked, sperm cannot be found because the sperm cannot come out and cannot descend to the testicles. In such cases, a very thin injection is inserted into the sperm channels or testicular tissue, and pieces are taken from them. The possibility of sperm being found in these parts is also very high.
If the sperm channels, which are the cause of azoospermia, are not blocked and there is little or no sperm production, the Micro Tese method will be the most logical choice. Because in cases where there is no or very little sperm production, a method such as removing tissue or parts from all parts of the testicles is not very healthy. There are thousands of mini-tubes within the testicular tissue, and within them there are different levels of sperm production. In other words, on the day of the procedure, sperm is produced in some tubes and not in others. When sperm is tried to be found with surgical practices, many parts will be damaged. However, in the micro tese method, the areas where sperm are found are first determined by using the surgical microscope and then the sperms are taken. In micro tese application, the ovaries are examined under general anesthesia, the sperm-producing areas are determined and the sperm cells found are extracted from the tissue.
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