Indications for surgical sperm retrieval: The procedure may help men who are unable to produce adequate sperm for a variety of reasons, including:
When there are no sperm in the ejaculate, sperm can sometimes still be recovered from the testicles by an operation.Today, sperm retrieval doctors use several different techniques to extract sperm.
EPIDIDYMAL SPERM RETRIEVAL
TESTICULAR SPERM RETRIEVAL
These procedures are carried out either under local or general anaesthetic. The sperm can be used either for diagnosis, immediate treatment, or frozen for use in the future treatments. Sperm obtained from this procedure normally need to be used for ICSI treatment.
EPIDIDYMAL SPERM RETRIEVAL TECHNIQUES INCLUDE:
Percutaneous Epididymal Sperm Aspiration (PESA), in which a needle is inserted through the scrotum into the epididymis (the duct that carries sperm from the testes to the vas deferens) and any sperm will be drawn through the needle into a syringe to collect sperm.
Microscopic Epididymal Sperm Aspiration (MESA), a minimally invasive surgical procedure in which tiny surgical instruments are used to collect sperm from the epididymis, aided by a microscope.
TESTICULAR SPERM RETRIEVAL TECHNIQUES INCLUDE:
TEsticular Sperm Extraction (TESE) / Open Testicular Biopsy– if few or no sperm are obtained from the above procedures a biopsy (tissue sample) is taken from the testicle through a small incision from which the sperm are then extracted. After the procedure 2-3 stitches are placed in the skin, these will dissolve after about 10 days.
Microsurgical TESE, in which a microscope is used to closely examine the tubules from which sperm is extracted; the goal is to extract sperm from the healthiest tubules, which improves the chances of extracting viable sperm.
The procedure involves exteriorization of the testis by making a single and large incision on the testicular capsule to expose the testicular parenchyma with the aid of the operating microscope at ×6-8 magnification.
During the procedure, identification of foci of clearly enlarged seminiferous tubules during micro TESE is to be differentiated with uniform distribution of collapsed seminiferous tubules.
MicroTESE has significantly improved sperm retrieval rates in azoospermia men, and is a safer procedure since less testicular tissue is removed and higher success rate os sperm retrieval. Patients cryopreserve sperm during this procedure for future IVF/ICSI. With Micro TESE, in 1/3rd of men sperm could be obtained where it was not obtained initially by TESA / TESE procedure. It is expensive, time consuming and needs expertise in performing the procedure.
Sperm Retrieval Surgery & Recovery: Sperm retrieval surgery typically takes about an hour and is done under local or general anaesthesia, depending on the specific collection technique used. You will not feel any pain during the surgery. However, if the surgery is done under local anaesthesia you may feel some discomfort during the procedure, such as pulling sensation.
Patients typically recover quickly from the sperm extraction surgery. You may feel slight discomfort and tenderness on the scrotum for the first 24 to 48 hours. This can be relieved with medications. Bruising and swelling may also occur, which should subside within the first few days. You should be able to return to your normal activities within three to five days after the surgery, and expect a full recovery within two weeks.
What are the side effects of sperm aspiration: The side effects include discomfort, pain, bruising, bleeding and the risk of infection.
The more invasive MESA and MicroTESE sperm retrieval procedures carry a higher risk of side effects and may require an overnight stay in the hospital. You will receive antibiotics to prevent infection, and pain medications to help manage any soreness of the treatment area.
Sperm Retrieval Success Rates:Sperm retrieval surgeries have a high success rate. However, the success rate of the sperm aspiration surgery depends on your individual situation and the underlying cause for the surgery.
Retrieval rate is almost 100% in cases with obstructive azoospermia. Approximately 50% -60% retrieval rates are possible in men with non-obstructive azoospermia.
Sperm Extraction-ICSI: Once the sperm is collected, it will be used to fertilize your partner’s egg via ICSI. Typically your partner’s eggs are collected the same day your sperm retrieval is performed. The egg is then fertilized in the laboratory with your sperm, and cultured for two to six days before being transferred to your partner’s uterus.
Sperm Retrieval & Artificial Insemination: Sperm extraction and artificial insemination are not typically done together. Sperm collected directly from the testis or epididymis is not mature enough to swim and fertilize the egg.
Sperm Retrieval & Sperm Freezing / Banking: After the sperm retrieval procedure, the sperm collected can be frozen and cryopreserved for later use. Sperm banking can help avoid the need for another surgical sperm retrieval process in the future. Many choose to freeze their sperm after sperm retrieval in case the first cycle of IVF is not successful and to keep their options should they want to father more than one child.
Transurethral Resection of Ejaculatory Duct in case azoospermia due to Ejaculatory duct obstruction:
This procedure eliminates obstruction in the ejaculatory duct which improves the chances of inflamed or chronically dilated areas within the ejaculatory duct to normalize.
(ART) ICSI and IVF:
Intracytoplasmic sperm injection (ICSI) has overcome virtually all forms of male factor infertility. The ICSI procedure is when a single sperm is injected into each ripe female egg. The ICSI procedure has enabled most of these patients to conceive their own genetic offspring. Success rates from this treatment are quite high and the track record to date suggests that there are no significant increases in birth defects in children that result from this procedure.