Sperm Retrival Techniques

Sperm collection is completely different from a diagnostic testicular biopsy because, in this context, the goal is not to identify what is happening in the testicle but to look for sperm. Only men without sperm in their ejaculation (azoospermia) need to remove sperm directly from the testicle or epididymis.

This may involve a simple aspiration for men who have a block or require a much larger sampling of the testicles for men who have a sperm production problem. As a result, there is a significant difference in the amount of time required, the need for anesthesia and the equipment used.

Very few tests allow an accurate prediction of the presence or absence of sperm in the testicles of men with testicular problems. Genetic tests can give an idea of the possibility of finding spermatozoa, but they are not absolute. The pattern of the testicular problem found at the time of a diagnostic testicular biopsy can be a bit predictive, but again there is no finding that absolutely foresees the presence or absence of sperm. Other blood tests, including hormonal studies, are not predictive.

Finally, even the fact that the sperm was found in a previous collection session does not guarantee that the sperm will be found in future collection attempts. Therefore, diagnostic testicular biopsy is not routinely performed in patients who have to undergo testicular sperm extraction when the cause of their zero sperm count is already established by other means.

The timing of sperm recovery

The timing of sperm collection along with the IVF cycle is a difficult issue to solve. There are advantages for and against sperm collection prior to the IVF cycle or in relation to collecting the female partner’s eggs. The final decision is made based on the preference of the IVF program. Perform the collection in advance and freeze the sperm until the eggs allow the couple to make an informed decision on whether to move forward with in vitro fertilization has been collected since in most cases the probability of finding sperm can be only 60 percent or less.

Furthermore, it is difficult for many couples to undergo operating procedures on the same day because it requires that they provide other resources to help them to and from the hospital and assist at home. IVF laboratories often prefer to work with fresh sperm rather than frozen sperm and, therefore, their desire for fresh spermatozoa outweighs all other considerations.

As a result, simple sperm recoveries are generally performed on the day of egg retrieval. Simple sperm retrievers are procedures performed on men with a known obstruction that produce sperm without problems. These procedures are summarized below and include testicular sperm aspiration (TESA), percutaneous sperm aspiration (PESA) and testicular sperm extraction (TESE).

Microdissection TESE (microTESE) is a much more complicated procedure and is done the day before removing the eggs from the female partner. MicroTESE is carefully coordinated with the reproductive endocrinologist and is performed, sometimes designated quarterly.

Recommended Sprem Retrieval Techniques

There are numerous ways to get sperm from a man with normal sperm production and a blockage. The simplest and most profitable is sperm aspiration. This is done regularly under local anesthesia and lasts about 10 minutes.

Collecting sperm from a man with a testicular problem is much more difficult and often takes several hours. The ideal procedure, microTESE is carried out with the help of an operating microscope, which increases the chances of finding spermatozoa and can minimize the amount of tissue removed from the testicle.

It is important to understand that the microscope used in the operating room does not have a sufficient increase in seeing the sperm, but simply helps determine which tubules within the testicle are more likely to contain sperm. Small amounts of tissue are sent to the IVF laboratory during the course of the procedure so that they can assess whether enough semen has been collected. The IVF laboratory uses a more powerful microscope to evaluate this tissue. Repeated biopsies of one or both testicles are obtained until enough sperm has been collected for that IVF cycle. Additional sperm can be collected to preserve for future IVF cycles if the current cycle has failed or the partner wants to have more children in the future. This procedure can last up to four hours depending on how fast the sperm is found.

Here is a summary of the available sperm collection procedures:

Testicular sperm aspiration (TESA)

TESA is a procedure that is performed for men who have removed sperm for IVF / ICSI. It is performed under local anesthesia in the operating room or office and is coordinated with the recovery of the eggs from your female partner. A needle is inserted into the testicle and the tissues/sperm are aspirated. TESA is performed for men with obstructive azoospermia (vasectomy s / p). Occasionally, TESA does not provide enough tissue/sperm and an open testicle biopsy is required.

Percutaneous aspiration of epidermal spermatozoa (PESA)

PESA is a de facto procedure for men who are sperm extracted for in vitro / ICSI fertilization with obstructive azoospermia or a previous vasectomy or infection. It is performed under local anesthesia in the operating room or office and is coordinated with the recovery of the eggs from your female partner.

Testicular sperm extraction (TESE)

TESE consists of making a small incision in the testicle and examining the tubules to detect the presence of spermatozoa. It is performed as a scheduled procedure or is coordinated with the recovery of your partner’s eggs. TESE is usually done in the operating room with sedation but can be done in the office only with local anesthesia. Patients usually cryopract sperm during this procedure for future IVF / ICSI. MicroTESE has replaced as the optimal form of recovery for men with sperm in their seminal fluid (azoospermia) problems with production.

Spermatic micro-epididymal aspiration (MESA)

The table is a procedure performed in men with vassal or epidídica obstruction (s / p vasectomy, bilateral congenital absence of the vas deferens). It is performed as a scheduled procedure or is coordinated with the recovery of your partner’s eggs. The MESA is performed in the operating room under general anesthesia using the surgical microscope. Patients usually cryopract sperm during this procedure for future IVF / ICSI. TABLE allows a large collection of mature spermatozoa compared to aspiration techniques and is the preferred method of recovery for men with congenital bilateral absence of the vas deferens as they do not affect the production of testicular steroids.

Microdissection TESE (microTESE)

MicroTESE is a procedure performed for men who have a sperm production problem and are azoospermic. MicroTESE is performed in the operating room under general anesthesia under the operating microscope. MicroTESE is carefully coordinated with the recovery of the female partner’s eggs and is performed the day before the eggs are recovered. This allows each partner to be present for the other’s procedure. Patients often have donor spermatozoa backed up if sperm is not found in the male partner. MicroTESE has significantly improved the sperm recovery rate in azoospermic men and is a safer procedure since the testicular tissue is removed. Cryopreserved sperm during this procedure for the future IVF / ICSI.