Sperm Retrieval Procedures
Men with no sperm when ejaculating (azoospermia) need to have sperm retrieved directly from the testis or epididymis.
This may be a simple aspiration for men who have a blockage or require much more extensive search of the testis for men who have a sperm production problem. As a result, there is a difference in the time taken, the need for anesthesia and the equipment used.
Very few tests allow accurate prediction of whether or not sperm will be found in the testes of men with testicular problems. Genetic testing may show if there will be a chance of finding sperm but are not absolute. Blood tests including hormonal studies are not predictive.
Even having sperm found on previous sessions does not guarantee that sperm will be found on future attempts.
The Timing of Sperm Retrieval
The timing of sperm recuperation in conjunction with the IVF cycle is a difficult matter to resolve. There are advantages for and against doing the sperm recuperation before the IVF cycle or in conjunction with the egg pickup of the female partner’s eggs. The final decision is made by the preference of the IVF program. Performing the harvesting in advance and freezing the sperm until the eggs are retrieved allows the couple to make a decision whether to go forward with IVF since in most cases the chance of finding sperm may be about 60%.
IVF clinics prefer to work with fresh rather than frozen sperm and thus their desire to have fresh sperm wins.
As a result, simple sperm retrievals are performed the day of egg pickup. Simple sperm retrievals are procedures performed in men with known obstruction who make sperm without a problem. These procedures include Testicular Sperm Aspiration (TESA), Percutaneous Sperm Aspiration (PESA), and Testicular Sperm Extraction (TESE).
Which Sperm Retrieval Procedure is Recommended?
There are lots of ways to recuperate sperm from a man with normal sperm production and a blockage. The simplest and most cost-effective is an aspiration of sperm from the testicles. This is routinely performed under local anesthesia and takes about ten minutes.
Harvesting sperm from a man with a testicular problem is much more difficult. The ideal procedure, micro-dissection Testicular Sperm Extraction, is done to take out tissues from the testis.
Small amounts of tissue are sent to the IVF laboratory during the course of the procedure so that they can search whether enough numbers of sperm have been recuperated. A powerful microscope is used by the IVF laboratory to evaluate this tissue. Repeated biopsies from one or both testes are obtained until sufficient sperm has been harvested for that IVF cycle. Extra sperm may be harvested to preserve for future cycles of IVF in case the current cycle is unsuccessful or the couple wants more children in the future. This procedure can take as long as four hours of sperm searching depending upon how quickly sperm are found.
Testicular sperm aspiration (TESA) is a procedure done for men who are having sperm retrieved for in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI). It is done with local anesthesia in the operating room and is done at the same time with their female partner’s egg retrieval. A needle is inserted in the testicle and tissue/sperm are aspirated. TESA is done for men with obstructive azoospermia or who had vasectomy. If TESA doesn’t provide enough tissue/sperm, an open testis biopsy is needed.
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA is a procedure performed for men who are having sperm retrieved for in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) who have obstructive azoospermia from either a previous vasectomy or infection. It is done with local anesthesia in the operating room and is with the female partner’s egg retrieval.
Testicular sperm extraction (TESE) or Biopsy
TESE involves making a small incision in the testis and examining the tubules for the presence of sperm. It is either done as a scheduled procedure or is coordinated with their female partner’s egg pickup. TESE is usually performed in the operating room with local anesthesia for men with no sperm in their ejaculation (azoospemia) from a problem with production. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI.
Microepididymal Sperm Aspiration (MESA)
MESA is a procedure performed for men who have vasal or epididymal obstruction (vasectomy, congenital bilateral absence of the vas deferens). It is either done as a scheduled procedure or is coordinated with the female partner’s egg retrieval. MESA is performed in the operating room with general anesthesia using the operating microscope. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. MESA allows for an extensive collection of sperm as compared to aspiration techniques, and is the preferred method of retrieval for men with congenital bilateral absence of the vas deferens (CBAVD).
Micro-dissection TESE (micro-dissection testicular sperm extraction)
Micro-dissection TESE is a procedure performed for men who have a sperm production problem and are azoospermic. Micro-dissection TESE is performed in the operating room with general anesthesia under the operating microscope. Micro TESE is carefully coordinated with the female partner’s egg pickup. Patients frequently have donor sperm backup in the case that sperm are not found in the male partner. Micro TESE has significantly improved sperm retrieval rates in azoospermic men, and is a safer procedure since less testicular tissue is removed. Patients cryopreserve sperm during this procedure for future IVF/ICSI