Techniques for obtaining sperm for use in IVF and ICSI
There are many causes for male infertility. Up to 15 percent of men with fertility issues have no sperm when they ejaculate. About half the time this is due to a blockage of the reproductive tract. Often a testicular biopsy is required to determine if the lack of sperm is due to no sperm being produced or due to a blockage. Sperm retrieval is only possible if at least some sperm production is present.
If there is a blockage of the reproductive tract, then sperm can be retrieved with special techniques. IVF (in vitro fertilization) is then needed to be able to achieve pregnancy.
There are several different surgical extraction procedures that can be done. Aspirated sperm is typically frozen to be used for IVF and ICSI (intracytoplasmic sperm injection) at a later date.
MESA (microsurgical epidydimal sperm aspiration)
MESA, also known as microepidydimal sperm aspiration, is the most commonly used aspiration technique. A very small incision is made in the scrotum and the epididymis (the tube that conducts sperm from the testicle) is seen. An operating microscope is used for magnification. Fluid is taken from the epididymis and examined under a laboratory microscope for moving sperm.
This technique can be scheduled in conjunction with the female partner’s egg retrieval or as a separate office procedure. MESA is performed in an operating room with the male under general anesthesia. MESA usually collects more sperm than other methods.
PESA (percutaneous epididymal sperm aspiration)
This can be done under local anesthesia, as sperm is aspirated without opening the skin (percutaneaous means made or effected through the skin). A small needle is inserted through the scrotum’s skin to collect sperm from the epididymis. It is less dependable and fewer sperm are collected.
MESA and PESA are used when sperm is stored but blocked from release.
TESE (testicular excisional sperm extraction)
If there is no sperm in the epididymis or if there is a sperm production issue due to testicular failure, these sperm can be extracted from the testicle itself. Testicular failure can be caused by injury to the testicles, chromosomal abnormalities, using certain drugs, testicular diseases and testicular torsion.
Either aspiration (pulling fluid out with a needle) or biopsy (taking a tissue sample) can be done with TESE. If there is a sperm production issue, then cutting open the skin to see the testicle is typically done. The surgery will often be done with an operating microscope.
TESE’s success is dependent on the quality of the sperm in the tissue sample.
At Advanced Reproductive Medicine we will do the surgical sperm retrieval before undertaking IVF on the female partner to ensure we have sperm before initiating the IVF procedure. Many infertility cases due to low sperm production are good candidates for ICSI, which can improve chances of egg fertilization by placing the sperm inside the egg where fertilization occurs.