What Is TESE & Its Success Rate

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TESE – Male infertility is common today and can be attributed to various underlying factors. The working of the male reproductive system is highly complex. Any malfunctioning tissue or blood vessel can lead to hurdles in the pregnancy journey. 

Luckily, medical advancements have made it possible to treat the cause of male infertility. One of the most successful procedures is TESE. 

But who is eligible to take help with this procedure? 

In this article, we will talk about TESE and its success rate. We will discuss in detail the procedure of TESE, its side effects, and the complications associated with TESE. 

Semen is not Sperm.

During sexual intercourse or masturbation, when a man has an orgasm, he ejaculates semen. A semen sample contains sperm cells responsible for fertilising the egg. Sperm cells are not visible to the naked eye. There is a possibility that the sperm cells are absent. Another reason can be poor sperm morphology or low sperm count in the semen sample. It is where the TESE procedure comes to your rescue. 

What is TESE?

TESE stands for testicular sperm extraction. It is a medical procedure to collect sperm cells directly from your testicles when, for some reason, they do not come out when you ejaculate. 

Other procedures that fall under the category of sperm retrieval processes are

  • Testicular Sperm Aspiration (TESA)
  • TESA with mapping
  • Percutaneous Epididymal Sperm Aspiration (PESA)
  • Micro Epididymal Sperm Aspiration (MESA)
  • Microdissection TESE (microTESE)

These are also known as sperm harvesting procedures. Each of them helps solve different problems related to infertility. 

But this article focuses on TESE, so let’s understand the need for this sperm retrieval process. 

What is the Need for TESE? 

TESE is needed to solve the problem of both obstructive and non-obstructive azoospermia (zero sperm in the semen). These two factors are responsible for a large number of male infertility cases.  

Obstructive Azoospermia

It is a condition in which testicles function normally and produce sperm, but they are absent in the semen due to some blockage. 

Obstructive azoospermia can be caused by primary testicular failure, non-reconstructed vasectomy, or the blockage is there by birth. 

Non-obstructive Azoospermia

This is a condition in which no sperm cells are produced due to the abnormal functioning of the testicles. 

So, we can say that testicular sperm extraction proves to be a boon when

  • The testosterone levels are normal, but the testes cannot produce sperm cells. 
  • An obstruction or blockage in the reproductive tract due to injury or infection prevents sperm from entering the penis.
  • Even after treating azoospermia, the sperm count has not improved significantly.

The sperm cells that are retrieved from the TESE procedure will be frozen. Then, whenever the doctor needs them for fertility treatment, they can use the frozen sperm cells to fertilise the egg. The TESE procedure has significantly reduced the need for donor sperm. 

Using Retrieved Sperm for Normal Conception 

The important thing to note here is that these retrieved sperm cells can’t be used for normal conception. 

When the sperm cells are collected directly from the testes, they can’t swim through the vagina. So, when placed inside the uterus, they won’t be able to reach the fallopian tube to fertilise the egg. 

These sperm cells can only be used in fertility treatment where fertilisation occurs on a petri dish in a laboratory. 

Preparation for TESE 

You may want to know what precautions to take before the TESE procedure. Here are a few suggestions from the doctors: 

  • Don’t take blood-thinning medications 5 days before the TESE procedure. These include Aspirin, Advil, Motrin, etc.
  • Nicely shave your genital area to minimise the chances of infection.
  • Shower with an antibacterial soap on the day of the TESE procedure or the night before.

TESE Procedure 

This delicate procedure is carried out under general anaesthesia so that the patient does not have a painful experience. 

With the help of a biopsy, active areas of sperm will be located. Then, one or two incisions (cuts) will be made in the scrotum. After that, a small portion of tissue is removed from the testes. This sample portion will be dissected to separate the sperm from the sample to store it and be used to fertilise the egg. The incision during the TESE procedure is closed with the help of sutures. 

It takes around 20 to 30 minutes to carry out the TESE procedure. 

Post-TESE Care

After TESE, your doctor will ask you to wear a special type of underwear called scrotal support for 2 weeks. You can also use tight-fitting underwear.

  • Bear in mind that a tissue was collected through incision from your testicles. So, rest is mandatory! 

But how much rest do you need post-TESE?

  • Resting for at least 2 to 3 days at home after the procedure is completed is best.
  • Don’t push yourself if you still feel discomfort or pain while doing something.
  • You are advised to shower the next day after the TESE procedure.
  • But be careful; the wound should not come in contact with water. It is because the wound is closed with the help of absorbable sutures and should not be removed. Also, the chances of testicular infection might increase.
  • A healthy, balanced diet will help fast recover the scrotal wound.
  • Lay an extra focus on consuming fluids during the recovery period.
  • Don’t engage in activities like jogging, swimming, or weight lifting for at least 2 weeks after the TESE procedure.
  • Medications will be prescribed to alleviate pain and prevent infection.
  • It is safe to place ice packs on the scrotum every few hours for the first 2 days.
  • Consider joining back at work after 2 weeks post TESE. Contact your IVF experts immediately if you feel discomfort after 14-15 days.

Rigorous activities can be taken up after 10 to 14 days, depending on your recovery rate. 

Post-TESE Complications

You might face the following complications after the TESE procedure: 

  • Normal bleeding
  • Swelling
  • Bruising
  • Slight discolouration of the scrotal skin
  • A thin, clear, and pink-coloured discharge from the incision for the first few days

There is nothing to worry about these post-TESE symptoms. They will gradually fade away as the incision spot heals. 

Risk Factors Associated with TESE 

A highly experienced specialist does this treatment. Even though this procedure is quite safe, you may encounter severe symptoms after the treatment. Some of the risk factors associated with this sperm retrieval process are: 

  • Skin infection
  • Side effects related to anaesthesia
  • Testicle infection following biopsy
  • Damage to testicle
  • No sperm retrieval in the semen
  • Sperm does not react well when stored frozen for the ICSI procedure.

The good news is that risks like testicular damage are rare, but there is always a chance. So, make sure to follow all the post-TESE recovery guidelines religiously. 

Success Rates of TESE

The success rates of the TESE procedure depend on some important factors, namely.

  • Amount of sperm that was retrieved during TESE
  • Whether the retrieved sperm is alive
  • The quality of the sperm in terms of the shape and size of the sperm cell should be optimal.

To fertilise the egg, the shape and size of the head, midpiece, and tail of the sperm should be normal. 

The success rate also depends on the man’s medical history.

Fertility experts claim that the sperm retrieval rate is higher in men with obstructive azoospermia. The retrieval rate is more than 70 to 80%. 

This high success rate means the testes function normally and can produce sperm. There is some obstruction that is preventing the sperm from coming out. 

Once the underlying cause is treated or TESE is carried out, fertilisation can occur successfully. Provided that the sperm is alive and has normal sperm morphology.

However, in men with non-obstructive azoospermia, the retrieval rate is between 20 to 50%. Because the testes are unable to produce sperm or produce less sperm than required, in this situation, the complexities increase, and TESE success rates decrease. 

Another contributing factor is the man’s genetic background. The success rate for men with genetic conditions like Klinefelter syndrome is 10% to 20%. 

The success rate of the sperm retrieved during TESE in helping couples achieve pregnancy with an ICSI procedure is around 55%. 

Other factors that affect Success Rates 

● TESE success rates also consider the surgical specialists’ skills and expertise.

● Many times, the role of lifestyle is neglected when discussing infertility treatment options. 

But the truth is your diet, managing stress levels, and involvement in physical activities also impact the success of the TESE procedure. 

TESE Costs in Srinagar, India 

The cost of the TESE procedure varies based on the location of the clinic, the complexity of the underlying condition, available facilities, and the expertise of the medical specialists. 

The TESE cost in Srinagar, India, is between 50,000 and 60,000 INR. 

However, some fertility centres like Imprimis IVF and Srinagar offer affordable treatment options. 

Why Choose Imprimis IVF? 

TESE procedure warrants experience and skills. Imprimis IVF Srinagar offers even more than that.

Offering the TESE procedure at an affordable price means we maintain the quality of our services. We at Imprimis IVF are a team of skilled and highly experienced professionals. A round-the-clock support system for our patients in need. Equipped with state-of-the-art infrastructure and machinery, we turn dreams into realities. 

Final Words

Infertility among couples is becoming more and more common these days. Fingers are typically pointed at women for not being able to conceive. But now we know that men, too, can be responsible for infertility. All the information on the internet can only give you an overview of the entire process of TESE. For more information, visit a trusted fertility specialist.

How ICSI can help with infertility

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How ICSI can help with infertility – It is a common misconception that infertility means IVF. We need to understand that infertility is a very broad topic. Moreover, the reason behind infertility is not common for everyone. The root cause and other factors, like the couple’s medical history, help decide the best fertility treatment.

In this article, let us explore which couples can take the help of ICSI and fulfil their dream of getting pregnant.

What is ICSI?

ICSI stands for Intracytoplasmic Sperm Injection. It is an Assisted Reproductive Technology that is immensely helpful in treating severe male infertility, abnormal semen, and ejaculation issues. In ICSI, a single healthy sperm is injected directly into the egg to increase the chances of conception.

Can ICSI be recommended to everyone? 

No. ICSI is recommended in certain cases only. A thorough medical examination of the male and the female is done to determine the root cause of infertility. ICSI is the best option when:

  • The sperm count is very low to perform IVF or IUI.
  • Antisperm antibodies are present in high concentrations in the semen.
  • The sperm cell is abnormally shaped, has low motility, or has no acrosome (an organelle that contains fertilisation enzymes and is in the front end of the sperm head).
  • The male has a vasectomy or a blockage in the reproductive tract that disrupts the production of sperm cells or prevents them from coming out during ejaculation.
  • Low-quality frozen sperm is used during treatment.
  • Preimplantation genetic diagnosis (PGD) is used.
  • The doctors are unable to detect the root cause of infertility.
  • There is some difficulty in fertilising the egg during IVF.
  • The couple has had multiple IVF failures.

What is the Process of ICSI?

ICSI comprises several steps, which are stated as follows: 

1. Ovarian Stimulation–

The first and foremost step in ICSI is stimulating the ovaries. Several injectable medications are given to the woman for about 10 to 12 days to stimulate the production of more mature eggs.

These ICSI injectable medications consist of Luteinising hormone (LH) and follicle-stimulating hormone (FSH). During the stimulation phase, the woman is asked to pay a visit to the clinic regularly for administration of medications, blood tests, and monitoring of the egg development process by the ovaries.

With medical advancements, self-administered ICSI injections are also available. The doctors will guide you properly about how to use them at home. Your fertility clinic will also provide videos and handwritten notes for the same.

After the ovaries produce enough eggs, a trigger injection is administered to the woman. The hCG trigger injection–human chorionic gonadotropin or buserelin, helps the eggs’ maturation. The embryologist closely monitors this process, and the egg retrieval process is carried out before ovulation based on the status of the egg’s health.

2. Egg Retrieval-

The egg retrieval process occurs after 10-12 days of ovarian stimulation. A thin needle under ultrasound monitoring is used for retrieval. This needle makes its way into each ovary to remove the egg-containing fluid. These eggs are carefully examined by the gynaecologist and then placed in a petri dish containing culture media. The whole egg retrieval process is done under anaesthesia and takes about 20 to 25 minutes.

 3. Sperm Retrieval-

The sperm from the male partner is thoroughly washed and prepared in the laboratory. The healthiest sperm cell for ICSI is chosen based on its motility, normal head shape, and overall appearance to increase the chances of fertilisation.

The sperm cell is retrieved either naturally or using surgical procedures stated as follows: 

  1. Testicular Sperm Aspiration (TESA)
  2. Percutaneous Epididymal Sperm Aspiration (PESA)
  3. Testicular Sperm Extraction (TESE)
  4. Micro Epididymal Sperm Aspiration (MESA)
  5. Microdissection TESE (microTESE)

4. Administering the Intracytoplasmic Sperm Injection-

A single healthy sperm cell is chosen and picked with the help of a thin glass needle. A highly skilled and experienced embryologist will inject a healthy sperm directly into the egg for fertilisation. This process is done with a special medical instrument called a Micromanipulator and an inverted microscope, which offers high magnification.

 5. Embryo Development-

After some days, tiny embryos are formed and carefully monitored for 4-5 days. Depending on the health, the embryo can be transferred from day 2 to day five. On the 5th day, the embryos will enter the blastocyst stage. The blastocyst embryos are preferred in ICSI because they have a high implantation rate and are more mature than Day 3 embryos. In some rare cases, day six embryos are transferred to the uterus.

6. Embryo Transfer–

If the embryo/s is healthy, it is transferred to the uterine cavity for implantation. Generally, one or three of the healthiest embryos are transferred by fertility experts. This process takes about 5-7 minutes and is undertaken without anaesthesia. The embryos with a small amount of fluid are loaded in a catheter inserted in the woman’s uterus. This fluid will help release the embryos into the uterine lining. The embryologist closely monitors the whole process with an external abdominal ultrasound.

General Instructions for a Successful Embryo Transfer 

A good clinic like Imprimis IVF will give you proper instructions to prepare yourself, like consuming liquids 30-40 minutes before reaching the clinic.

It would help if you arrived with a full bladder as it helps to track the uterus lining for proper placement of the embryo/s. The embryologist will inform you about the development and the number of embryos that should be transferred to increase the chances of conception.

How long does it take to confirm pregnancy after ICSI? 

The pregnancy test after ICSI should be done two weeks after the embryo transfer.

Male Infertility that can be treated with ICSI 

ICSI is witnessed to be the best treatment option to address male infertility. The following medical conditions related to male infertility can be successfully treated with ICSI:

  • Oligospermia– A condition where the sperm count in the ejaculation is below 15 million per millilitre of semen. A male has a normal sperm count when the semen sample contains more than 15 million sperm/ml. 
  • Azoospermia– A condition in which no sperm cells are found in the semen.
  • Teratozoospermia– A situation in which the semen sample contains abnormally shaped sperm cells that cannot swim through the uterus to reach the egg to fertilise it.
  • Asthenospermia– A situation in which the semen contains slow-moving or less motile sperm.
  • Anitsperm Antibodies- As the name suggests, these antibodies treat sperm cells as foreign particles and kill them.

The minimum sperm count for ICSI is 4 million sperm/ml of semen. 

Benefits of ICSI Treatment

  • ICSI offers a high fertilisation rate of approximately 80%.
  • ICSI is one of the best Assisted Reproductive Technologies to tackle male infertility.
  • ICSI can help couples with multiple IVF failures.

How much does ICSI Treatment Cost? 

The cost of Intracytoplasmic Sperm Injection in India depends on the seriousness of the infertility issue, medications, geographic location, success rate of the clinic, and the expertise of the embryologists and gynaecologists. On average, the treatment cost of ICSI lies somewhere between INR 90,000 to 2,50,000. 

How Successful is ICSI the first time? 

ICSI offers a high fertilisation rate of 80-85% when the treatment is done by a highly experienced fertility specialist using the best practices.

Is ICSI better than IVF? 

Both ICSI and IVF have a similar success rate. ICSI is the best option in case of severe male infertility, whereas IVF is recommended for female infertility with poor egg quality. It completely depends on the root cause of the infertility, personal needs, and medical conditions of the couple.

Final Word about How ICSI can help with Infertility

ICSI is also a wonderful option to treat male infertility. The chances of success increase when you choose the right fertility clinic, like Imprimis IVF, Srinagar. Why? This treatment demands close examination using the latest medical tools and personal attention that only an experienced IVF specialist can offer. ICSI can be what you seek, so consult a trusted gynaecologist. That’s all about How ICSI can help with infertility problems.