Session 1: Primary investigation of the infertile couple
Transcutaneous testicular Sperm extraction (TESE) is in our department a routine procedure when azospermia is found. That is, after the man has been investigated, including karyotyping, counselling about Y-deletions (see later).
The procedure does not take more time than an ordinary oocyte pickup, - and no premedication is given. The TESE procedure is always done the day before the oocyte retrieval from the women, as the spermatozoa are allowed during the night to separate spontaneously from the testicular tissue by swim-out.
The surgical procedure:
Following disinfection of the skin a local analgesia is placed in the skin and directly into the testis underneath the tunica albuginea, i.e. only a maximum of 0.5 cc in the testis ( we are using Lidocaine 2% w/o adrenaline), using a hypodermic 21G needle. After 2 minutes a syringe filled with 5 ml of tissue culture medium and mounted with a normal venous needle is used to aspirate a needle biopsy directly from the testicular tissue. The needle is retracted from the testis and when it is leaving the skin the biopsy is freed from the skin. During the aspiration a rather forceful vacuum is applied. The biopsy is then expelled into a Petri dish and transported to the laboratory.