Sperm aspiration refers to the group of procedures used to obtain viable sperm from the male reproductive tract. The collected sperm are intended specifically for use with intra-cytoplasmic sperm injection (ICSI). A frequently asked question is can the sperm harvested by these techniques be used for insemination? There are not enough sperm retrieved to perform intrauterine insemination (IUI) regardless of the technique used to harvest the sperm. Usually enough sperm are obtained for ICSI and freezing, but at least 5-8 million mature (passed through the epididymis) motile sperm with normal morphology are required for IUI. Sperm aspiration is reserved for men who have the most severe types of male factor infertility including no sperm in their ejaculate (azoospermia) or sperm that are not motile or are dead (necrospermia).
There are two main reasons why sperm may be absent from the semen (necessitating sperm aspiration).Obstructive azoospermia is the result of a blockage in the male reproductive tract. Sperm production in the testicle is normal but the sperm are trapped inside the epididymis.
Non-obstructive azoospermia is the result of severely impaired or non-existent sperm production. It is precisely these situations that require advanced reproduction technologies such as ICSI to establish a pregnancy.
Four different techniques can be used to obtain sperm and each has a different name and acronym. The procedures have clear cut advantages and drawbacks and not all are applicable to every situation. A thorough knowledge and understanding of the cause of the patient’s infertility and pathophysiology of the disease process are essential prior to recommending and performing any procedure. Sperm harvesting techniques used to obtain sperm from men with obstructive azoospermia include the following:
MESA stands for microsurgical epididymal sperm aspiration. It is optimal way of obtaining sperm in those men with a reproductive tract blockage (i.e., after a vasectomy, congenital absence of the vas deferens). The epididymis (organ above the testicle where the sperm are stored) is isolated through 1/2 inch incision made in the scrotal skin .An operating microscope is used to examine the very small tubules of the epididymis that contain the sperm .A dilated tubule is opened and the fluid is collected and examined for the presence and quality of sperm. All of the sperm containing fluid is collected and taken to the IVF lab for processing, use and freezing. If the fluid is devoid of sperm or only dead sperm are found, then another area of the epididymis is sampled. This is done until enough sperm are obtained to use and to store for future use.
PESA – A needle is placed into the epididymis in the hope that a pocket of sperm will be found and aspirated.
TESE stands for testicular sperm extraction. It is an open procedure performed under direct vision and therefore minimizes potential complications. A small piece of testicular tissue is removed through a 1/2 inch skin incision. The tissue is placed in culture media and morsalized into tiny pieces. Sperm are liberated from within the seminiferous tubules where they are produced and are then extracted from the surrounding testicular tissue. This can be an exhaustive process depending on the degree of sperm production.
It can be performed in an operating room or office procedure room using a local anaesthetic. We recommend mild sedation for patient comfort. Sperm harvested usingTESE can be frozen and stored for later use.
TESA or testicular sperm aspiration is a needle biopsy of the testicle. It is an office procedure performed under local anaesthesia. A small incision is made in the scrotal skin and a spring loaded needle is fired through the testicle. While it is possible to retrieve sperm using this technique, the amount is often low because the needle cuts a thin sliver of tissue
Sperm aspiration (when performed using the appropriate technique) is usually a very successful, minimally invasive procedure that allows even men who make very few sperm to conceive a child of their own. Our goal is to provide the safest, most effective patient care and to collect as much good quality sperm as possible to minimize the need for future multiple surgeries.