If your sperm count is low or there is no sperm in your semen, which means there is no point in carrying out a standard fertility treatment, though surgical sperm collection is still possible. In this article, let us understand some of the standard microsurgical sperm aspiration techniques.
What is azoospermia?
Azoospermia is the complete absence of sperm in the ejaculate. It may result from obstruction of the genital ducts (like in the case of vasectomy) or from poor/absent production of sperm in the testicles. Today, minimally invasive techniques are available to retrieve sperm from the testicle. Once sperm is retrieved, pregnancy is possible with the use of intracytoplasmic sperm injection (ICSI). Choosing the right type of sperm retrieval method depends on the reason for azoospermia. However, not all men will have sperm found in the testes, irrespective of the surgical technique used.
Who might have sperm aspiration via surgically?
You may be a candidate for microsurgical sperm aspiration if you have no sperm in your semen due to a blockage (obstructive azoospermia). This could be because you have had a vasectomy or you have had a sexually transmitted infection like chlamydia.
You may also have surgical sperm retrieval if you are unable to ejaculate (retrograde ejaculation or anejaculation) or if you have sperm production problem (non-obstructive azoospermia). The following are some of the reasons for inadequate sperm production:
- You have had chemotherapy or radiotherapy and your fertility hasn’t returned to normal
- you have a genetic condition that affects your fertility
- you have had a testicle removed (perhaps as part of cancer treatment)
- you have had surgery to bring down undescended testes.
Microsurgical sperm retrieval techniques:
Sperm can be aspirated from the male reproductive tract through the three minimally-invasive aspiration methods. The most appropriate technique for you should be chosen after consultation with the surgeon and the conclusion of specific diagnostic tests, if needed. In majority of cases, retrieved sperm will be cryopreserved for future use of assisted reproductive technology.
Testicular Sperm Aspiration (TeSA):
TESA is also referred to as Testicular Fine Needle Aspiration (TFNA). It involves collection of sperm from a biopsy or several biopsies from the testicular tissue. It can be done either in the urologist’s clinic or in the operating room. The procedure is carried out under local anesthetic. TESA can be used to diagnose or treat azoospermia. Before the procedure, one or both the testes are numbed, then through a thin needle skin is punctured to pull out the sperm from the testicular tissue. No other cuts are needed. The ideal candidates for TESA are men in whom the sperm are being produced in adequate quantities throughout the testicles. This is a no-incision procedure. It requires only a few hours of hospital stay. It is quick and a relatively pain-less procedure.
Percutaneous Epididymal Sperm Aspiration (PESA):
Like TESA, PESA can be done many times at low cost, that too without an incision. The procedure is generally reserved for men who have a blockage in the epididymis or congenital absence of the vas deferens (the drainage tube for sperm from the testis to the penis), is the cause for no sperm in the semen. PESA does not call for a high-powered microscope, so more urologist can do it. Choice of anesthesia can be either general or local. The micro-surgeon sticks a needle attached to a syringe into the epididymis to gently remove fluid. It is in the epididymes where sperm is stored, after it is formed in the testes. If the sperm does not come out this way, a surgical process is needed. Unlike TESA, here sperm is retrieved from epididymis which is more mature and may have better survivability after cryopreservation. The patient can get back to work the same day.
Microsurgical Epididymal Sperm Aspiration (MESA):
MESA is performed under general anesthetic. It involves the use of a surgical microscope to examine the epididymis in order to retrieve sperm from the epididymis tubes. A needle is inserted via this incision and the fluid is aspirated. Further examination of the fluid collected is done in an embryology laboratory to see if there is any sperm. This technique works well on patients where sperm are being produced in adequate numbers but are blocked from traveling from the testicle to the ejaculate.
In fact, MESA can retrieve lots of healthy sperm that can be saved and frozen for later. Although this procedure does require an incision, it general allows the highest quantity of sperm to be retrieved. This method is very safe. However, it calls for a highly skilled micro-surgeon as it involves identifying tubes that are most likely to contain sperm. Compared to sperm harvested directly from the testicle, sperm harvested from the epididymis is considered better quality because they have had more time to mature.
In all the above three techniques, after examination of the collected material, you will be informed about the quality of the biopsy taken and whether there is any sperm present. Sperm are assessed by an andrologist and cryopreserved using appropriate techniques in order to be used at a later stage. These sperms are then thawed and used to inject the eggs obtained during IVF treatment using the technique of intracytoplasmic sperm injection (ICSI). If microsurgical sperm aspiration is successful, usually enough sperm is obtained for several cycles of treatment, if required.
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