Unfertile & Unfiltered
In this episode, we talk through the five biggest things we wish we had known before doing a microTESE. After going through the surgery and learning more after the fact, we realized there were several conversations we wish had happened sooner. We discuss genetic testing, how diagnosis can affect the odds of finding sperm, why overall success rates are not the same as your personal success rate, and why it matters to involve your IVF clinic before scheduling surgery. We also talk about Matt’s testosterone levels after surgery, the symptoms we noticed months later, and the importance of asking direct questions about hormone risks before moving forward. We get into recovery, anesthesia, constipation from pain medication, and the practical things that would have made the process easier. * onobstructive azoospermia (overall): Approximately 47% chance of finding sperm. * Complete AZFa deletion: Near 0% chance of finding sperm. * Complete AZFb deletion: Near 0% chance of finding sperm. * AZFc deletion: Approximately 47% average chance of finding sperm, with guideline estimates ranging from 50–75%. * Klinefelter syndrome: Approximately 44–50% chance of finding sperm. * Sertoli Cell-Only Syndrome: Approximately 22–41% chance of finding sperm. * Prior failed MicroTESE (salvage procedures): Approximately 18–43% chance of finding sperm. This is where we’ll include the different microTESE sperm retrieval odds based on diagnosis, including non-obstructive azoospermia, AZFa deletion, AZFb deletion, AZFc deletion, Klinefelter syndrome, and Sertoli cell-only pattern. 1. Does your lab prefer fresh or frozen microTESE sperm, and why? 2. What are your lab’s fertilization and live-birth outcomes with frozen-thawed testicular sperm? 3. How often does your lab see usable sperm survive thawing? 4. How do you freeze very small numbers of sperm: individual sperm, microdroplets, tissue pieces or standard vials? 5. What happens if only one or two usable sperm are found? 6. Would you recommend coordinating the procedure with egg retrieval in our specific case? 7. What happens to the eggs if no sperm is found? 8. Should we have donor sperm available as a backup? 9. If sperm is found, how many IVF attempts could the stored sample realistically support? 10. Who will search the tissue, and how long will the laboratory continue searching? 11. Will tissue be evaluated during surgery so the surgeon knows whether to examine the second testicle? 12. Can the urology lab and IVF embryology lab communicate directly before the procedure? This is where we’ll include the questions we recommend asking your urologist and IVF clinic before surgery, including questions about genetic testing, testosterone, fresh vs. frozen sperm, timing with egg retrieval, backup donor sperm, lab protocols, and what happens if only a small number of sperm are found. This episode is not medical advice, but it is the conversation we wish someone had walked us through before surgery. If you are considering a microTESE, we hope it helps you ask better questions, get clearer answers, and understand the tradeoffs before making a decision.
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