From Surgery to IVF: What Happens to Your Sperm After TESE/TESA Extraction?
After undergoing TESE (Testicular Sperm Extraction), TESA (Testicular Sperm Aspiration), MESA, PESA, or microTESE, your sperm embarks on a carefully orchestrated journey to maximize its chances of creating viable embryos. Here's what happens behind the scenes in the IVF lab:
Immediate Post-Procedure Handling (0-60 Minutes)
Operating Room to Lab Transfer
Extracted testicular tissue is immediately placed in warm culture media (37°C)
Transported to embryology lab within 15 minutes to preserve viability
Initial Processing
TESE samples: Mechanically minced with sterile scissors
That’s right, the lab will mince these tissue samples up into tiny pieces so that the sperm can be released from the issue!
TESA aspirates: Filtered to remove blood and debris
Treated with collagenase enzyme (if dense tissue) to release sperm
Key Fact: Testicular sperm are initially immotile - they typically gain motility after 2-4 hours in culture medium. This right here is critical information because many new embryologists don’t know this and assume the non-motile sperm are not “good”. Sperm typically gain motility during their transit through the epididymis (where maturation occurs). Testicular sperm bypass this step; therefore, the culture medium acts as an artificial environment to trigger motility.
**Not all labs have an operating room nearby, so often times the operating rooms will have to get the TESA/TESE samples delivered to a lab within 0-60 minutes.
The Sperm Search (Hours 1-4)
Embryologist's Process:
Examines tissue under 400x magnification using phase-contrast microscopy
Most labs will use a high-powered Inverted Microscope
Uses special counting chambers (Makler or MicroCell)
Documents all viable sperm locations
What They're Looking For:
Even a single sperm can be used for ICSI
Priority given to:
Motile sperm (if any become active)
Sperm with normal morphology
Vital sperm confirmed via hyposmotic swelling test
Success Rates:
Obstructive azoospermia: 90-95% find sperm
Non-obstructive azoospermia: 40-65% with MicroTESE
Key Fact: We are looking for any sperm at all. The whole reasoning to do this type of sperm collection is because of azoospermia, a condition where a man has zero sperm, therefore any sperm (motile or non-motile) is a great sign. There are tips and tricks to get a non-motile sperm moving!
In reality, this search could take upwards of 4 hours. The reason it doesn’t go on for that long is because the embryologist will burn out or sperm will die out within that time frame outside of an incubator. There has been advances in sperm search technology, and Columbia University Fertility Center may have found a way to use AI for finding sperm!
Sperm Preparation (Hours 4-6)
For Recovered Sperm:
Placed in sperm-friendly media (e.g., SpermRinse)
Incubated at 37°C with 5% CO₂
Selected via:
ICSI (single sperm injection)
PICSI (hyaluronan binding for mature sperm)
MACS (magnetic sorting for DNA-intact sperm)
Cryopreservation Options:
Excess sperm vitrified using cryoloops
or the lab’s choice
Post-thaw survival: 50-70% for testicular sperm
What Patients Should Know
Even a single sperm can succeed - Labs are equipped for extreme cases
Fresh sperm often outperforms frozen - Coordinate timing with your clinic
Ask for documentation - Many labs provide sperm/embryo photos
Fresh sperm TESA/TESE is preferred for better results, but if sperm is extremely limited, request testicular sperm freezing before ovarian stimulation to avoid cycle cancellation.
Final Thoughts
Many situations can be formed after the TESA/TESE procedure, so it is critical that labs are experienced in these situations. Each situation can make a difference in the final outcome, so it is always best to approach this IVF process with realistic expectations.
We’ve had patients do TESA/TESE on the day of the egg retrieval procedure, and it worked out amazingly. We’ve also had patients do TESA/TESE on the day of the egg retrieval procedure we’ve had to freeze the eggs because no sperm was found after surgery. Sometimes the surgeon can’t get it, sometimes the male patient can’t make it, and sometimes the lab can’t find it. At the end of the day, we’re all trying and hoping for the best!
“No swimmers in the stream? Worry not! Thorm descends with needle and might to retrieve them from the shadows!”
