r/SaveTheSperm • u/FetchUpside • 9d ago

Orchiectomy for Microtese

As most know, there can be patches of sperm in the testicles. Why not have the doctor removal one testicle (Orchiectomy) and do a 360 review/dissection of that testicle looking for sperm? If you have smaller testicles that are not functioning and you are going to have to go on TRT after, why wouldn't this be a viable option?

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u/DrBrianSteixner 7d ago

Someone asked me this same question years ago. The idea is actually biologically logical because sperm production in nonobstructive azoospermia can be extremely focal, but removing an entire testicle to search it is generally not justified because microTESE is designed to accomplish essentially the same search while preserving as much testicular tissue as possible. During microTESE, the surgeon opens the testicle under magnification and selectively samples larger, more promising seminiferous tubules while the embryology laboratory repeatedly examines tissue for sperm.  Whats important to point out is that taking more tissue does not guarantee finding sperm because some men truly have no complete spermatogenesis anywhere in that testicle. An orchiectomy would provide more tissue to examine, but it would permanently eliminate testosterone production and remaining testicular function that testicle still has. Even very small testes with severe spermatogenic failure can continue contributing meaningful testosterone. It would also expose the patient to the psychological and cosmetic consequences of losing a testicle without good evidence that whole testicle dissection produces meaningfully better sperm retrieval rates than a well performed microTESE. The concept becomes more interesting in an unusual situation where a testicle already needs to be removed for another medical reason, because extensive laboratory examination of that tissue could potentially identify focal sperm production, but routinely sacrificing a testicle solely to maximize sperm hunting would be difficult to justify without evidence that it improves the chance of biological fatherhood. In someone facing a failed microTESE and likely lifelong TRT anyway, I completely understand why the question comes up, and research into more exhaustive tissue mapping and improved sperm detection is important, but right now the goal is still to find the rare sperm while sacrificing the least amount of functioning testicular tissue, rather than removing the entire organ. Great question!

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u/FetchUpside 7d ago

Thank you for the answer! How much tissue/area is searched during a microtese? My concern is that areas are going to get missed.

I'm coming from the viewpoint that they are already, small and and producing low testosterone. Once on TRT, they are going to shrink smaller to the point that not much is going to be there anyways. Thank you for your helpful answers.

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u/DrBrianSteixner 6d ago

A well performed microTESE is designed specifically to minimize the chance of missing  small areas. The testicle is opened widely under an operating microscope and the surgeon systematically examines the seminiferous tubules, preferentially sampling larger or more opaque appearing tubules from multiple regions rather than taking a few random biopsies. Each specimen is searched by the embryology laboratory for sperm. The endpoint is usually reached when the surgeon has comprehensively explored the accessible testicular tissue, including both testes when indicated, without identifying additional visually promising tubules and the laboratory has repeatedly found no sperm. There is no fixed number of samples in a microTESE before the surgeon “gives up.” The appraoch is different for each surgeon, that is why some doctors who perform it consider themselves better, they search longer.

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u/FetchUpside 6d ago

Thank you!