Sperm Retrieval Proedures

Sperm retrieval is entirely different from an investigative testicular biopsy.  In this scenario, the aim is not to discover what is transpiring in the testicles but to locate sperm.

Only males having nil sperm in their azoospermia (ejaculated semen) require sperm salvaging directly from their epididymis or testis.

This may involve a simple aspiration method for males confronting a blockage or fertility issue or may require larger sampling of the testicles for males having issues with the sperm production. Hence, there is a considerable difference in the time period it takes, the requirement of anesthesia and the tools and the equipment utilized.

There are a very few examinations that predict accurately the presence or absence of sperm in the semen or testis of men having testicular issues. Examining the male genetically may provide clues for locating sperm, but even that kind of revelation cannot be relied upon.

The sequence of the testicular issues discovered during the investigative testicular biopsy time may be somewhat predictive.  Yet again, there is no evidence that can predict absolutely the absence or the presence of sperm in the testis. Moreover, the blood examinations that measure the presence of hormones are also not found to be predictive.

Conclusively, even the sperm located during the earlier retrieval procedures do not guarantee the presence of sperm during the future retrieval efforts. Therefore, an investigative testicular biopsy is not customarily done on patients who are likely to go through testicular sperm retrieval while the reason of their having nil sperm has already been established from other sources.

The Sperm Retrieval Timing

The sperm retrieval timing coinciding with the IVF treatment cycle is a difficult proposition to decide on. There are pluses and minuses of performing the sperm retrieval earlier to the IVF treatment cycle or combining the procedure with his female partner’s egg retrieval process.

This crucial decision is taken considering the choice of the IVF treatment program. Doing the sperm retrieval in advance and then freezing the sperm till the eggs are retrieved helps the involved couple in making an informed decision. They can very well decide whether to go in for the IVF or not since the chances of locating sperm may be only 60 per cent, or even less.

Furthermore, it is hard for several couples go in for surgical procedures concurrently on the same day. For doing so, they require to recruit other resources for helping them to go to the Clinic and back home, besides arranging post-procedure help at home.

The IVF labs commonly favor working with fresh sperm in comparison to frozen ones. So, their wish to get fresh sperm takes precedence over all other considerations.

Appropriately, the easy procedures for sperm harvesting are commonly performed on the day of the egg retrieval. The simple sperm harvesting procedures are performed in males who are producing sperm normally but have obstructions.

These procedures are briefly explained below.  They are:

  • Testicular Sperm Aspiration (TESA)
  • Percutaneous Sperm Aspiration (PESA)
  • Testicular Sperm Extraction (TESE)

Microdissection TESE is a procedure that requires extra involvement and is done on the day earlier than his partner woman’s egg retrieval. The procedure is performed in a coordinated manner with the reproductive specialist in a chosen period of time after a break of every three months.

How to choose sperm retrieval method?

There are several ways of sperm retrieval from a male with the usual production of sperm but confronted with blockage. The cost-effective and yet the simplest way is the sperm aspiration. This is usually performed by giving a local anesthesia and hardly takes 10 minutes.

The sperm retrieval from a male having testicular issue is far more complicated and consumes a lot of time. The idyllic method known as Microdissection TESE (Testicular Sperm Extraction) is done with the help of an operative microscope. With this, the probability of locating sperm becomes higher and the minimal tissue amount is culled out of the testicle.

It is imperative to know that the microscope that is used in the operating theatre does not have enough intensification for identifying the sperm. But it certainly helps in identifying the tubules in your testicles that may have a larger number of sperm.

Thus, the tissue having a good quantity of sperm is culled out from the testicles and sent to the IVF lab during the procedure. The lab in charge afterwards ascertains whether enough number of sperm has been retrieved.

A microscope, having extra magnification, is utilized in the IVF lab for evaluating this tissue. More than one biopsy is taken from one or both the testicles until enough number of sperm have been retrieved for the scheduled IVF cycle.

Sometimes, additional sperm are retrieved for preserving them for the future IVF cycles if the scheduled cycle fails or in case the couple plans to have more babies in the future. The procedure may take as long as 4 hours depending on how swiftly the sperm are located.

Given below is the abstract of all the available sperm retrieval procedures.

Testicular sperm aspiration (TESA)

TESA is a sperm retrieval method for males used for performing intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF) procedures. In this procedure, local anesthesia is given in the operation theatre and is synchronized with his partner female’s egg retrieval procedure.

A needle is introduced in the testicle for retrieving the sperm.  TESA is done in males having status-post vasectomy (obstructive azoospermia).  At times, with TESA the doctor does not get enough sperm/tissue and an open biopsy from the testicles is required.

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is a sperm retrieval method for males for carrying out ICSI or IVF.  It is generally performed on males confronting obstructive azoospermia because of some infection or earlier vasectomy.  It is performed in the operation theater by giving local anesthesia to the involved. The procedure is usually synchronized with the egg retrieval process of the concerned male’s female partner.

Testicular sperm extraction (TESE)

The TESE procedure entails giving a small cut (incision) in the testis and performing the tubules investigation to ascertain the existence of sperm in them.   It is either performed as a planned procedure or is synchronized with the egg retrieval of his female partner.

TESE is generally done in the operation theater by giving sedation or local anesthesia. Males generally cryopreserve their retrieved sperm for carrying out ICSI or IVF.

Of late, Microdissection TESE is becoming the preferred procedure.  It is being considered the most advantageous kind of sperm retrieval process for males having nil sperm in their azoospermia because of issues with sperm production.

Microepididymal Sperm Aspiration (MESA)

MESA is another procedure done on males having epididymal or vassal obstruction because of inborn absence of the vas deferens or the post-vasectomy.

It is either performed as a planned procedure or synchronized with the egg retrieval process of the female partner.  MESA is done in the operating theatre by giving general anesthesia with the help of the operating microscope.  Patients usually cryopreserve sperm in this procedure for carrying out future IVF/ICSI procedures.

MESA helps in a larger collection of sperm compared to the aspiration methods and is preferred in males facing Congenital (inborn) Bilateral Absence of Vas Deferens (CBAVD).

Microdissection Testicular Sperm Extraction (TESE)

As the name denotes, in Microdissection TESE procedure a microscope is used for classifying the sperm.  The procedure is performed on males confronted with the fertility issue of sperm production by giving general anesthesia.

Microdissection TESE is vigilantly synchronized with the egg retrieval process of the female partner and is generally done one day before the egg retrieval. This helps both the partners in assisting each other’s procedure.

The couple confronted with infertility often a sperm donor backup if the enough sperm are not located in the male partner.  With the Microdissection TESE procedure, the retrieval rates of sperm have considerably improved in azoospermic males. Besides, the procedure is considered safer as the minimal testicular tissue is eliminated.  Couples confronting infertility generally cryopreserve sperm for their use in future ICSI/IVF cycles.

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