Sperm retrieval as a method of treating male infertility.
Sperm retrieval is a option for men who do not have sperm in their semen due to a blockage, an absence of the vas deferens, or when a vasectomy reversal has been unsuccessful.
Vas deferens
Some men have no sperm in their semen because of a blockage or an absence of the vas deferens. The vas deferens is a tube leading from the testis towards the penis. Sperm travel down this tube and leave the body during ejaculation. Such men may be producing a large number of sperm, but the absence of the vas deferens prevents them from being present in semen. This is similar to what takes place when a man has a vasectomy.
In cases such as this, sperm can be obtained from the epididymis. If the epididymis is blocked or absent, sperm can be extracted from the testicles.
Assisted Reproductive Technologies
Assisted reproductive technologies (ART) may be administered to place the closer to the egg as a means to achieve pregnancy. ART procedures include:
- Microepididymal sperm aspiration (MESA)
- Testicular sperm extraction (TESA)
MESA or microepididymal sperm aspiration
At Urology Austin, our providers routinely perform first time and repeat vasectomy reversals. Our doctors are also approached about the possibility of combining a sperm retrieval procedure with in vitro fertilization. This approach can serve as an alternative to a vasectomy reversal, or in cases of non-correctable duct obstruction (such as the congenital absence of the vas deferens). Microsurgical epididymal sperm aspiration (MESA) is commonly performed for men with vasal obstruction.
During a MESA, a scrotal skin incision is made, and the testis and epididymis are exposed. Using an operating microscope, a single epididymal tubule is located and sperm is aspirated. The procedure may be performed with a general or local anesthetic with intravenous sedation. MESA is oftentimes, the procedure of choice due to an ability to retrieve a large number of sperm. This sperm can be used immediately, or cryopreserved (frozen) to be used in future cycles. Many men may be candidates for a reconstructive vasoepididymostomy (vasectomy reversal) at the same time of the sperm harvest, increasing the chances of having sperm appear in the ejaculate. Recovery time from the MESA procedure is generally a few days, and complications are rare.
TESE or testicular sperm extraction
For approximately 7% of men, undergoing microsurgical epididymal sperm aspiration (MESA) is not possible. Critical to the success of the TESE procedure, is determining whether or not the testes are making mature sperm. If mature sperm with complete tails are present, the TESE is feasible.
Current best practice is to perform a small diagnostic testes biopsy prior to proceeding with testicular sperm extraction (TESE). Because of the low number of sperm obtained with TESE, an extracted sperm needs to be combined with an egg that has been retrieved through an IVF (in vitro fertilization) cycle.
TESE (testicular sperm extraction) procedure
During a TESE procedure, a fine needle is inserted into the testicle to obtain tissue samples. These samples are then examined under a microscope. If sperm missing, a tissue sample (testicular biopsy) is taken through a small incision in the scrotum and testicle. At this point, sperm can be extracted from the tissue.
Surgically retrieved sperm are immature and incapable of fertilization by conventional means. Fertilization is achieved using an Intracytoplasmic Sperm Injection (ICSI). This procedure involves injecting a selected sperm into the cytoplasm of a mature egg.
After the operation, patients may feel discomfort, experience bruising, and feel tenderness in the scrotum for 24 to 48 hours. Also, there is a small risk of infection and bleeding after the procedure. A firm scrotal support is recommended until discomfort subsides.
Any spare sperm or testicular tissue may be frozen for later use, thus avoiding another sperm retrieval procedure. In the event that sperm are not found, the couple may decide to cancel egg collection and abandon treatment, or proceed with the egg collection and inseminate the eggs with donor sperm.
If you have questions about sperm retrieval, contact Urology Austin to schedule an appointment with one of our providers.