Azoospermia, which occurs in about one in ten men, is a condition in which there are no dead or live sperm cells in the semen. Azoospermia is among the causes of infertility in men. Azoospermia is a disease that can be seen due to many sub-causes, and some sub-causes can be resolved by applying surgical methods. For example; in cases of obstructive azoospermia, a thin needle is inserted into the obstructed ducts or testicular tissue and small pieces are removed. The rate of finding sperm in these parts is high and the chance of success is quite high. In cases of non-obstructive azoospermia, there is very limited or no sperm production in the testes. The causes of non-obstructive azoospermia can be genetic or infections during puberty. In such cases, doctors usually perform microsurgical testicular sperm extraction, also known as testicular sperm extraction, MicroTESE-TESA procedure. This is the most up-to-date and reliable biopsy method, which has replaced all other techniques in recent years. In this method, a biopsy is performed under a specially designed microscope. Therefore, sperm are detected better than in sperm production centers. What is Micro TESE? Nowadays, even men who have no sperm in their semen or whose sperm count is normal, but all of their sperm are immobile, can have a chance to have a child with IVF treatment. In these patients, reproductive cells can be found through some surgical procedures on the ovaries. The most recent and most successful biopsy method is microdissection thesis, which uses a special operating microscope to search for sperm. With this method, the testicle is opened, sperm ducts are observed, enlarged and full sperm ducts are visualized and sperm are tried to be obtained from them. With very clear and detailed visualization of the ducts, sperm can be found in men who cannot obtain sperm. This method is used even if there is no sperm in the semen, due to the presence of small areas in the ovary that produce sperm. The operation continues until sperm is found. It is an operation that takes an average of 2 hours. Since the genital area is a bleeding risk area, the patient may have problems such as bleeding risk and infection risk after the operation. For this reason, the doctor’s instructions should be followed after the operation. There is no test that can show whether sperm will be present in the testicle without this procedure. Hormone levels, urological examination findings, genetic results of the patient, imaging methods performed before the procedure provide information about the possibility of sperm. What is TESA? In male patients with normal sperm production but no sperm in the semen, the cause is usually an obstruction of the sperm ducts or the absence of a sperm duct. In such cases, Mesa, which is a surgical operation, Testicular Sperm Aspiration, which removes sperm with a needle, and Testicular Sperm Extraction, which is a method of removing sperm from the testicle with the help of a biopsy, are used. Testicular Sperm Aspiration is performed under local anesthesia or sedation. With the help of a thin needle, the fluid obtained from the testicular tissue under negative pressure is examined under a microscope. Sperm cells are tried to be detected. If cells are found, they are frozen and stored. It can be thawed and used for IVF treatment. If this method does not provide enough tissue or sperm, the patient may need an open testicular biopsy.

• Deficient sperm production
• Primary testicular problems
• Obstruction in the genital tract
• This method is used in people who have undergone vasectomy or failed vasectomy reversal.

What Causes Azoospermia? The absence of sperm in the ejaculate, i.e. semen, is the result of a number of conditions. These conditions are as follows:

• Disorders in hormone structure
• Influence of genetic factors
• Undescended testicle
• Blockages in the sperm ducts
• Prolonged exposure to radiation
• Side effects related to medication use
• Drug addiction
• Some infections that prevent sperm formation

As a result of the effect of such situations, sperm cells are negatively affected. Micro TESE-TESA The method is applied on male patients who face these problems and generally successful results are obtained. The success of the operation is closely related to the cause of the disturbance in sperm activity. Sometimes no sperm cells are found during the operation. Advantages of the Micro TESE-TESA Method Micro TESE-TESA We have listed the advantages of operations as follows:

• It causes minimal damage to the testicular tissue.
• Since minimal damage is done, the testicle heals more quickly than with other methods.
• Thanks to a special microscope setup, a small amount of tissue is removed from the testicle.
• This method, which is applied through a small incision under anesthesia, is a painless surgical procedure.
• The chances of finding sperm with this method are very high.
• Compared to traditional biopsy techniques, it is a technique that has a higher chance of finding a larger number of sperm and preserving them through freezing.
• The chance of getting quality sperm increases. This increases the likelihood of a successful pregnancy.

How is Micro TESE Surgery Performed? First, general anesthesia is applied and the patient is completely asleep. It can also be performed under local anesthesia, but general anesthesia is preferred because it is a detailed and concentration-demanding operation under the microscope. It is necessary for both the comfort of the patient and the concentration of the physician. Then, a large transverse incision is made on the testicles. The testicle is opened by passing under the skin and layers. A 20-30 times magnification is provided with an operating microscope and the thin channels called tubules in the testicle are examined under this microscope. Normal or enlarged tubules are collected and broken down. Sperm, the male reproductive cells, are examined inside. After the sperm is found, all layers are closed again in accordance with their anatomical positions and the procedure is terminated. Then the laboratory phase begins. Live sperm cells are subjected to a number of procedures and separated. Healthy sperm cells are injected into the egg to ensure fertilization for use in IVF treatment. Which Patients is Micro TESE-TESA Applied to? Every azoospermic patient, Micro TESE-TESA is a candidate for implementation. Once azoospermia has been diagnosed, the patient should undergo a genetic examination. The Y chromosome, which determines masculinity, should be well evaluated at this stage. On the Y chromosome, there is the AZF region and a, b, c sub-regions responsible for sperm production. Partial or complete deficiencies of these regions can lead to problems with sperm production. Sperm production is not possible in the complete deficiency of AZF A region, in the complete deficiency of AZF B region or in the complete deficiency of all three regions. Therefore, these patients Micro TESE-TESA is not practiced. However, this method can be applied to all other patients and there is a chance to obtain sperm. Where is Micro TESE Performed? This procedure is performed in the operating rooms of IVF centers licensed by the Ministry of Health. If sperm are found during the procedure, these sperm are used in IVF treatment.

When is MicroTESE-TESA Performed?

Micro TESE-TESA when it will be done is determined by the doctor. The woman’s factor and preparation are also important in determining this time. The date is usually tried to coincide with the day the egg is retrieved. Who Performs Micro TESE-TESA Surgery? These applications are performed by Urology-Andrology specialists. As IVOX Hospital, we offer our services with our legally authorized doctors who are professional and experienced in their field. Is Micro TESE-TESA Surgery Difficult? Micro TESE-TESA is, after all, an operation. Every operation has its own complications. Opening, bleeding or infection of the surgical site after the operation are some of the risks. In addition, pain and discomfort may occur in the testicles for a certain period of time after the operation. However, compared to other operations that affect vital functions, it can be considered a simpler and less risky operation. It does not pose a serious risk to life. The rate of damage to the testicular tissue is almost negligible. During the operation, the testicle area is enlarged 20-30 times. In this way, the operation area can be seen clearly and in detail. The magnification of this area allows the doctor performing the operation to work easily. This ensures that the operation is performed safely. When Should TESA/Micro TESE be Decided?

• In case of obstruction in the sperm ducts
• Congenital absence of sperm ducts
• In the absence of sperm output due to genetic or hormonal reasons
• Exposure to treatments that affect sperm structure or production, such as radiation or chemotherapy
• In cases of infections such as mumps in youth or adulthood
• In cases of using drugs that may impair sperm quality or health

In such cases Micro TESE-TESA application must be decided. What to Consider When Surgically Removing Sperm?

• To obtain a sufficient number of healthy sperm for IVF treatment
• Obtaining the best quality sperm
• No damage to reproductive organs
• The technique used is effective, up-to-date and reliable

Which Tissues Are Used for Obstructive Azoospermia?

• Testis (with Mesa and Pesa methods)
• Epididymis ( Micro TESE-TESA methods)

How Long Does Micro TESE Surgery Take? The duration of the operation is determined by whether sperm can be found. On average, the operation takes 2 hours, but sometimes it can take more than 2 hours. If healthy sperm is found, the procedure can be terminated in a very short time.

• Previously made Micro TESE-TESA operations
• Possible health problem of the person
• Characteristics of testicular tissue
• The structure of the tubules to be sampled affects the operation time.

Which Testicle is Used When Searching for Sperm with Micro TESE? There are no specific selection criteria for surgery. If no sperm is found, both testicles can be operated on. In the presence of two testicles, the doctor decides which testicle to start looking for sperm from based on the patient’s current medical characteristics. First, one testicle is searched for sperm. If needed, the second testicle is used. How Many Times Can Micro TESE Be Performed in IVF Treatment? After the procedure, the sperm cells are frozen and specially stored in tubes under laboratory conditions. The quality of the frozen sperm does not deteriorate. Therefore, there is no need for this procedure again in a second IVF treatment. These frozen sperm cells can be used for 5 to 10 years. However, sometimes sperm cells may not be found in the patient during the procedure. For these patients, a second application can be performed with a 6-month interval. In addition, samples are taken from the testicles of patients with no sperm and sent to the pathology unit. These sample tissues are examined in detail in the pathology unit. If Sperm Is Not Found in the First Micro TESE, Will It Be Found in the Second Application? In azoospermic patients, if the first attempt to obtain sperm from testicular tissue is unsuccessful, a second application can be performed after 6 months. If the first attempt is unsuccessful, samples of testicular tissue are taken and sent to pathology. If the pathology unit gives approval for the second application after the necessary examinations, a second operation is performed after 6 months. According to the studies, there is a chance of finding sperm in the second application according to the reasons for failure in the first application. What is the Probability of Sperm Survival after Sperm Freezing? Yapılan çalışmalara göre dondurulmuş spermler çözüldüğünde, ortalama %50’si canlı kalabilmektedir. Testis dokusundan elde edilen spermler henüz taze iken %90’ı canlıdır. Ancak yalnızca %5’i hareketlidir. Spermlerin çözdürme işlemi sonrası canlılığını gösteren en önemli faktör hareketliliktir. Çözdürme sonrası hareketlilik oranı ciddi bir oranda azalmaktadır. Ancak elde edilen sperm miktarı fazla ise, spermlerin dondurulup çözülmesi sonrası hareketli sperm bulunmasında bir problem yaşanmaz. IVF Treatment After Micro TESE-TESA Application Micro TESE-TESA sperm cells taken from the man are subjected to various processes by embryologists. After the procedures, they are microinjected into the woman’s ovary to fertilize the egg cell. In the following period, it is monitored whether the pregnancy develops or not. If the result is negative, the procedure can be repeated with frozen sperm. Do Pregnant Women Have Problems After the Operation? Women who become pregnant after this application continue their pregnancy no differently from women who are pregnant in the normal way. What is the Success Rate of Micro TESE in IVF Treatment? Micro TESE-TESA the chances of finding live sperm cells:

• General health status of the patient
• Hormonal characteristics of the patient
• It depends on the patient’s genetic inheritance.

What is the Sperm Finding Rate in Micro TESE-TESA Operation?

• If the patient has sufficient testosterone according to the sperm test results
• If azoospermia is present despite treatment

Micro TESE-TESA prosedürleri ile sperm bulma oranı yaklaşık olarak %70’tir. Yapılan araştırmalara göre, bu operasyon en yüksek sperm elde etme oranını vermektedir. Ayrıca testiste en az zarara neden olmaktadır. Before Micro TESE-TESA Application Patients diagnosed with azoospermia, Micro TESE-TESA should undergo a detailed urologic examination before surgery. After a hormonal and genetic examination, if deemed necessary by the urologist, preoperative preparatory treatment can be planned. No sexual abstinence is recommended for patients before the operation. Before the operation, the patient stops eating and drinking water at night and comes to the clinic hungry.

• At least 6 hours of fasting is required.
• The genital area should be clean. The genital area should be shaved.
• Post-operative pain in the operation area is one of the expected conditions. For this reason, pieces such as sweatpants should be preferred instead of pants when coming to the clinic.

What are the Risks of Micro TESE-TESA Operation? Micro TESE-TESA We have listed the risks of the operation as follows:

• Postoperative bleeding may occur as a result of small incisions.
• Pain may occur after the operation.
• Since the surgery is performed on the genital organs, hormones can be affected due to tissue damage. However, it returns to its normal state within 6 months after the operation.

What Should Be Done After Micro TESE Application?

• After this operation, the effect of anesthesia wears off after about 2 hours and the patient can be discharged.
• The patient should avoid heavy physical activity for at least 10 days.
• The patient should not have sexual intercourse for 15 days.
• After 2 days following the operation, the operation area should be dressed.
• You can take a shower 3-5 days after the operation.
• Painkillers can be taken for postoperative pain.
• The patient should not wear tight underwear for 10-15 days.
• There is no need to remove the stitches as they will dissolve on their own.
• After the operation, ice compress can be applied to the operation area.
• If there is bleeding after the operation, the doctor should be contacted.
• It is necessary to avoid long journeys after the operation.
• In order for the patient to be comfortable and pain-free after the operation, it is recommended to wear underwear called suspensory underwear.

When Does Swelling Go Away After Micro TESE Operation? Micro TESE-TESA In the early period of the operation, swelling occurs in the genital area due to edema. This condition passes in approximately 2-4 weeks. The genital area regains its normal state at the end of this period. What Should Be Done If Swelling Does Not Go Away After Micro TESE Operation? Micro TESE-TESA If swelling remains for more than one month after the operation or if there are conditions such as bruising, temperature increase, redness with swelling, the doctor should be consulted regardless of the duration. Is There Any Harm in Micro TESE-TESA Surgery? Micro TESE-TESA surgery is a surgical method used due to infertility in men. It allows sperm to be found and extracted by surgical methods in people who have no sperm in the ejaculate. In this way, individuals have the chance to have a child. With this method, healthy sperm are obtained. The operation does not cause any harm. Is Sexuality Affected After Micro TESE Surgery? Micro TESE-TESA sexuality afterwards is usually unaffected. However, in the case of small testicles, a large amount of testicular tissue removed or a defect in testicular production of the male hormone testosterone, sexuality may be affected, albeit partially. In cases where sperm was not found during the operation, it has been observed that psychological factors come into play after the operation. This negative psychology can negatively affect the sexual life of the person as well as his/her whole life. Is Micro TESE Necessary to Have a Child? For men who have no sperm in their ejaculate, i.e. semen, and cannot produce Micro TESE-TESA there is no other treatment method. What is the Difference Between Classic TESE and Micro TESE? Unlike the classical operation, the testicle is opened transversely through a single wide incision. The sperm-producing tubules in the inner and lower regions of the testicle are examined at high magnification with the help of a special microscope. With high magnification, channels with larger and fuller diameters within the tubules can be preferred. Micro TESE-TESAIt helps in the selection of tubules that produce sperm, those that are close to normal or fuller. The diameter of the tubules is about 3 times that of a normal hair. With the naked eye or at low magnification, it is impossible to distinguish between near-normal tubule diameters and narrower or wider tubules. By taking tissue samples from areas with near-normal or enlarged tubules Micro TESE-TESAprovides a higher chance of finding sperm than the classical operation. Micro TESE-TESA method, less testicular tissue is removed and more sperm are obtained. In non-obstructive azoospermic male patients, testicle sizes are smaller than normal testicle sizes. Micro TESE-TESA method, 70 times less tissue loss was detected compared to the classical method. For this reason Micro TESE-TESA method ensures that male hormone levels remain at the preoperative level after surgery, with minimal tissue loss. Micro TESE-TESA It has been reported that the male hormone level does not change and remains stable. In some non-obstructive azoospermic male patients, the level of male hormone may be low before the operation. The hormone levels of these male patients can be determined before the operation and medication can be administered to restore the male hormone levels to normal levels. After the operation, it is important for patients to go for routine follow-up visits. A clearer and more detailed view of the vascular structure through a special microscope ensures that these vessels supplying the testicle are protected during the operation. Thus, after the operation, deterioration of the nutrition of the testicle or shrinkage of the testicle is prevented. Micro TESE-TESA Prices Micro TESE-TESA Prices vary according to whether an additional application is made to the operation. Additional procedures such as pathological examinations after these surgical applications, freezing of the sperm cells found will change the cost. However, our prices are affordable compared to the quality service we provide. As IVOX hospital, we offer you our services with our experienced and professional doctors, authorized staff, up-to-date and healthy practices. You can safely choose our hospital for health. You can contact us to get detailed information about our applications, to get information about our fees or to make an appointment at our hospital.