First I will generally detail what can be derived from a repeated surgery, and later on I will refer to the histopathological finding: Chances of success of a repeated operation for the extraction of mature sperm cells, are dependent on a number of factors – type of first operation, lab quality, and more. What we can do, is perform the treatment procedure better – such as preliminary hormonal treatment to encourage the production of sperm, performing the surgery in the advanced Micro-TESE method, referral to a leading lab specializing in sperm cell search to search the tissue, and more. In this manner, we have much better tools to try and extract sperm cells despite the failure of the first time. Regarding the Spermatogenesis arrest finding – Spermatogenesis is a general name for the sperm production process, and such a pathological finding in surgery means that such a process is taking place, but there is some type of arrest that for some reason prevents the sperm cells from developing into mature cells. I can cautiously say that this finding is positive, due to the fact that it indicates that a sperm production process is taking place in the testicles, which gives us hope despite the arrest in production. However, when we will treat it in a better and with better quality, we will be able to encourage the production of sperm in the testicle and find several mature sperm cells. Apart from this, around the world and in Israel, methods for fertilization using primary sperm cells (round spermatids), which give us hope that in the future, maybe even the near future, it will be possible to try and fertilize eggs using the primal sperm cells that exist in the tissue.

Testosterone is produced in the testicles, and it has 2 functions: 1) Contributes to the proper functioning of the testicles in terms of the sperm production process, 2) Passes through the blood stream to various tissues in the body and is highly significant for proper male health. In direct testosterone treatment, (by applying gel or injections), the testosterone reaches only the bloodstream and not the testicles, which causes the suppression of the sperm production process. Therefore, when you desire to raise the level of testosterone impairing fertility, it should not be treated by taking testosterone directly but rather by encouraging the testicles to manufacture more testosterone using medication (Clomifene tablets, Anastrozole, or Pregnyl injections).

However, the treatment process must be conducted carefully, to integrate the various treatment manners, and not to stop the patient from taking testosterone directly all at once. The treatment is adjusted by a doctor who is a specialist in male fertility (Andrologist), who has endocrinology training, or by an endocrinologist with a speciality in male fertility, and it is carried out after an in-depth investigation of medical history, volume and texture of the testicles and more. Details on the various treatment methods can be found in the article page on the Multidisciplinary Center for Male & Female Fertility website.

There are several ways to treat Obstructive Azoospermia: TESA – Aspiration of sperm from the testicles using a needle, TESE – Open testicle biopsy. The disadvantage of these two methods is that the amount of sperm extracted is limited, as well as they require the extraction of tissue from the testicles, which may impair the production of the male hormone, testosterone. Another method is PESA – The aspiration of sperm from the epididymis using a needle. Its disadvantage in it is also the limited amount of sperm extracted, as well as the fact that it is done “blind” without the doctor seeing which tissues he touches. An additional method is the MESA – the extraction of sperm from the epididymis using microsurgical means. This method is preferable due to the large amount of sperm extracted, as well as because the use of a microscope during surgery, through which the surgeon can see the tissues he goes through, making sure that the impact is minimal. Sperm extraction using the MESA method, can be done by a doctor who has had Andrological microsurgical training only.

Usually, cases of low sperm count are not intended for surgery. You must see an Andrologist to assess your medical condition and adjust the treatment. Sometimes it is possible to achieve a state which allows for a natural pregnancy, and sometimes fertility treatment must be sought, depending on the severity of the problem, level of hormones, level of Varicocele if present, and more.

Hello. In a sperm extraction surgery using the TESE method, tissue is randomly removed from the testicle, from a limited number of areas in the testicle, so there is still a possibility that in other areas of the testicle, the process of sperm production still takes place. On the other hand, in Micro-TESA surgery, a selected tissue is removed after examining the testicular tubules under a microscope, locating the tissue that has a higher potential for producing sperm out of all the areas in the testicle. The TESE surgery does not provide a complete indication that no production of sperm takes place in the testicle, and there’s logic in performing a repeated surgery using the advanced Micro-TESA method. Also, like in any surgery for the extraction of sperm, and particularly in a repeated surgery, special care must be taken that the entire pre-surgery treatment is done to the highest level of quality, such as hormonally preparing the patient in order to get him to surgery in an optimal condition, performing the surgery at a hospital which has a quality lab, delivering part of the tissue to an external Andrology lab specializing in deep sperm search, and more. For more information on this subject, please see the article in the article page on the Multidisciplinary Center for Male & Female Fertility website. For a consultation with an Andrologist (male fertility specialist) regarding a repeated surgery, it is recommended to arrive with your histopathological results from the first operation, provided a sample from the surgery was sent for this analysis. Good luck!

Hello A’. The MESA surgery has 2 major advantages: 1) The potential to extract a larger amount of sperm is significant. 2) Preserving the testicle – the operation is done in the area of the epididymis, and not on the testicle itself. This point has great importance for preserving the potential of testosterone production in the testicle – a hormone which is of high significance for men.

In Israel, there is a limited number of doctors which perform the MESA surgery. This surgery requires a designated Andrological-surgical training. The operation is performed under a special surgical microscope. The doctor gently opens the testicular tissues and aspirates the liquid containing sperm in a very precise manner. The duration of the operation is about two hours or more. The advantage of a TESA operation is that it is simpler, takes less time (15-30 minutes), and its availability in the health care system is higher. I personally perform both types of surgeries in obstruction cases, according to the wishes of my patients. Regarding the TESA operation – the recovery time should not take longer than a few days, after which it is possible to gradually resume physical activities, subject of course to the instructions of the treating physician. The recovery time from the MESA surgery is similar. Good luck.