Figure 3.

Microsurgical Sperm Retrieval Techniques. Operating microscope and microsurgical techniques are used throughout the procedures. The top image shows microsurgical epididymal sperm aspiration (MESA). After exposure of the testis and epididymis, a dilated epididymal tubule is dissected and opened. Fluid is aspirated, diluted with sperm medium and sent to the laboratory for examination. The bottom images show microsurgical testicular sperm extraction (micro-TESE). A) After the testicle is exteriorized, a single and large incision is made in an avascular area of the albuginea to expose the seminiferous tubules. B) Dilated tubules are identified and removed with microforceps (intraoperative photograph at 40X magnification). C) Illustration of the histopathology cross-section of a dilated seminiferous tubule with active spermatogenesis. D) Illustration of the histopathology cross-section of a thin tubule with Sertoli-cell-only syndrome.