Male infertility is on the rise. Semen quality and sperm counts are falling. The only male is now responsible for 40%. This is an increase from 25% earlier. The falling sperm counts have been blamed on lifestyle factors like poor diet, stress, lack of exercise, alcohol, smoking and cell phones. Besides this men could suffer from azoospermia which means no sperms are present in the ejaculated semen. This can be due to obstruction of the vas deference or it could be due to testicular failure where sperm production is affected. In cases where there is testicular cause there may be sperm production but only in few localized areas which are not enough to show sperms in the ejaculate. In both these cases, we usually do a testicular sperm extraction by aspiration of epidydimus or testis or a testicular biopsy. In many of the cases where sperm production is present in occasional areas, it is difficult to identify these areas by naked eyes. However, under the microscope dilated seminiferous tubules containing sperms can be identified. Thus a new technique is evolved where in the testicular biopsy is done under magnification of 25 times. This is known as Micro TESE (Testicular sperm extraction). It is done under general anaesthesia. With the help of this sperm, extraction is more successful. The conventional biopsy is taken blindly and often multiple sites have to be taken as the initial biopsy tissue may not have sperm. The advantage of micro TESE is that since targeted biopsy under the microscope identifies seminiferous tubules with a higher chance of having sperms, hence more successful and requires less amount of tissue leading to less tissue destruction. It is a surgery which takes 3-4 hours. The sperms are then taken and an Intracytoplasmic sperm injection (ICSI) is done in the oocyte (egg). This technique is a milestone in the advancement of treatment of men with non-obstructive azoospermia who want to father a child. The facilities for microTESE are only there in few centres in India. These centres are equipped with a microscope within the operation theatre. It is advised that men with azoospermia ( absence of sperms) get treated only at centres with the facility of microTESE.
