TESE and ICSI: Why are the two combined for successful results?

TESE and ICSI are two related treatments that help with male factor infertility. Men who do not generate sperm during ejaculation may have less sperm in the testicle, which can be extracted by TESE and used with ICSI to conceive a child.

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TESE and ICSI are interconnected procedures that help with male factor infertility. Men who do not produce sperm during ejaculation may have lower amounts of sperm within the testicle that can be used with ICSI to conceive a baby. Sperm from the testes can be utilized to fertilize eggs in the lab. The number of recovered sperm is frequently low. As a result, TESE and ICSI are frequently used in conjunction.

TESE Treatment Procedure

TESE (Testicular Epididymal Sperm Extraction) is a surgical treatment that removes a tiny amount of testicular tissue and extracts sperm from it. This sperm retrieval process is utilized for fertility treatments where the male does not have any sperm in his ejaculate. 

TESE is used to treat men with both obstructive and non-obstructive azoospermia. These men have no sperm in their ejaculate because there is a barrier in the route between the point of sperm production (the testes) and ejaculation, or because sperm production in the testes is partially or entirely cut off.

Right Time for Conducting TESE

The doctor may recommend that TESE be performed before beginning any reproductive treatment to ensure that sperm production is occurring. If sufficient amounts of sperm are found in the current instance, it is occasionally possible to freeze the testicular extract and then thaw and use it for future treatment. More often, once sperm production is established, the TESE technique is repeated on the day of egg retrieval, with a fresh sample utilized for ICSI. Again, if there are sufficient quantities of sperm present, the sample can be frozen for use in future treatment cycles.

TESE: Pre-Operative Instructions

  • For five days, refrain from taking any medication that thins the blood.
  • Shave the scrotal area the same day to reduce the risk of infection.
  • Shower with an antibacterial soap the night before or on the morning of the procedure.

TESE: Post Operation Recommendations

Following the TESE surgery, the patient will be observed for several hours before being discharged the same day. Bedroom rest is required, with ice given to the scrotum for the first 24 hours. The patient will be required to wear a scrotal support, which is a form of underwear, for four to five days after surgery. A tiny degree of swelling/bruising is common throughout the healing process, and the discomfort should lessen within two to three days.

The following are some of the common discomforts or symptoms experienced post TESE, that do not require a doctor’s attention:

  • The scrotal skin is bruised and somewhat discolored. This typically goes away in about a week.
  • Slight scrotum swelling. You may notice “notches,” which are temporary swellings at the suture area, if sutures are applied.
  • A very tiny amount of thin, transparent, pinkish fluid may ooze from the wounds for a few days following the surgery. The region should be kept clean and dry.

ICSI Procedure and its Advantages

ICSI (Intracytoplasmic Sperm Injection) has transformed the management of male infertility. ICSI is used to boost the likelihood of fertilization when fertility rates are expected to be lower than normal. Normally, to fertilize an egg, the sperm must first reach and adhere to the egg before pushing through the egg’s outer layer to enter the cytoplasm. ICSI is the direct injection of a single sperm into a mature egg. This increases the likelihood that fertilization will occur. It can help overcome any difficulties the sperm may have in reaching or entering the egg.

ICSI is a successful treatment for male-factor infertility. ICSI can overcome the negative impact of abnormal sperm characteristics and quality on fertilization if viable sperm is available since the procedure bypasses the shell and delivers the sperm directly into the egg. ICSI enables couples with male factor infertility to attain live birth rates comparable to those obtained with in vitro fertilization (IVF) using standard techniques of fertilization in men with normal sperm counts. ICSI can be conducted on men who have no sperm in their ejaculate if sperm can be successfully retrieved using TESE.

Step-by-Step Process of ICSI

  1. The initial stage in the ICSI process is egg retrieval.
  2. Usually, hormones are administered to mature the egg follicles and ensure that a few viable eggs are present for retrieval. 
  3. Your IVF doctor will then retrieve the eggs from the follicles and use them for the ICSI treatment.
  4. The next step is to find healthy sperm.
  5. Here, a fresh semen sample is taken to the lab, where our experts pick a healthy mature sperm for the ICSI procedure. The process removes all debris, dead cells, and seminal plasma.
  6. Later, the selected sperm is collected in a tiny needle, called a micropipette, and then injected into the mature egg.
  7. After that, under expert observation, the healthy developed embryo most likely to survive is implanted back into the uterus.

ICSI Treatment Helps Whom?

The ICSI procedure used in IVF is an advanced treatment. If a couple has difficulty with sperm motility, sperm count, and poor quality sperm, ICSI treatment combined with IVF can improve the chances of success.

IVF-ICSI treatment is most suited to couples in the following conditions:

  • Lack of sperm production in the male
  • Cannot avail other treatments such as IUI or IVF
  • Multiple IVF failures 
  • Unexplained infertility
  • Inactive, unhealthy, or poor quality sperms
  • Abnormally shaped sperms
  • Low sperm count
  • If the sperm cannot attach to the egg.
  • When the male reproductive tract is blocked


How many sperm are needed for ICSI?

Intracytoplasmic Sperm Injection (ICSI) is a specialized method of IVF used to treat severe male-factor infertility. ICSI is the direct injection of a single sperm into a mature egg.

Does ICSI select the best sperm?

Multiple approaches are used to prepare sperm samples in order to remove low-quality sperm. Embryologists examine the remaining healthy sperm at great magnification. The embryologist uses a thin glass needle to choose the best-looking sperm.

Why select ICSI IVF?

The following reasons can help you understand when you must select ICSI in IVF and why:
– Increases fertility rates for couples unable to conceive due to male infertility.
– Increases the number of high-quality fertilized eggs produced from a single egg collection.
– Suitable for men with extremely low sperm counts or sperm motility difficulties.

What is the success rate of TESE in IVF?

Globally, TESE success rates typically range between 50% and 70% in situations of obstructive azoospermia, which occurs when sperm production is hampered by a physical barrier. This significantly higher success rate is owing to the fact that the testes continue to produce sperm, although restricted from reaching the ejaculate.

Can you freeze TESE sperm?

TESE is often performed in the operating room under sedation, yet it may also be performed in the office using local anesthetic only. During this surgery, patients frequently cryopreserve their sperm for future IVF/ICSI treatments.

What is the ICSI treatment cost?

The cost of a single ICSI cycle varies from person to person. Your charges will include the cost of injections to boost multiple egg production, the cost of the embryology lab procedures, and the freezing of extra high-quality embryos.

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