microTESE revolutionizes surgical management of male factor infertility

Denise Asafu-Adjei, MD, MPH

Urology Times® is celebrating its 50th anniversary in 2022. To mark the occasion, we are highlighting 50 of the top innovations and developments that have transformed the field of urology over the past 50 years. In this installment, Denise Asafu-Adjei, MD, MPH, discusses the development of microsurgical testicular sperm extraction (microTESE). Asafu-Adjei is a urologist and medical director of male reproductive medicine at Loyola University, Chicago, Illinois.

Please provide an overview of the development of microTESE.

Microsurgical testicular sperm extraction, or microTESE, was first described by Peter Schlegel, MD, in 1998 and has really revolutionized surgical management for male factor infertility. It was developed to combine the advantages of a less invasive approach with an open excisional biopsy for sperm extraction.

What makes microTESE an innovation in urology, and how has it improved patient care?

Using the magnification of a microscope, compared with surgical loupes, you can better target seminiferous tubules to obtain sperm. Additionally, testicular trauma is significantly minimized using a microscopic approach because you can minimize damage to testicular and arteries and you can achieve more precise hemostasis. Micro TESE is associated with higher sperm retrieval rates compared with conventional testicular sperm extraction, so this approach has really become the gold standard for sperm extraction in patients with non-obstructive azoospermia