Sperm Retrieval Procedures
With TESA or TESE Increase Success Rate
Sperm Retrieval Procedures
What Is It: It is a procedure performed for men who are having sperm retrieved for IVF/ICSI. There are numerous ways to harvest sperm from a man with normal sperm production and a blockage. The simplest and most cost-effective is an aspiration of sperm. TESA is routinely performed under local anesthesia and takes approximately 10 minutes.
Why: It is a procedure performed for men with no sperm in their ejaculate (azoospermia) need to have sperm retrieved directly from the testis or epididymis.
When: The timing of sperm harvesting in conjunction with the in vitro fertilization (IVF) cycle is a difficult matter to resolve. There are advantages for and against doing the sperm harvesting prior to the IVF cycle or in conjunction with the harvesting of the female partner’s eggs. The ultimate decision is made by the preference of the IVF program. Performing the harvesting in advance and freezing the sperm until the eggs are harvested allows the couple to make an informed decision about whether to go forward with IVF, since in most circumstances the chance of finding sperm may be only 60 percent or less.
Here is a summary of the procedures available for sperm harvesting:
TESA: Testicular Sperm Aspiration
TESA is done with local anesthesia in the operating room or office and is coordinated with their female partner’s egg retrieval. A needle is inserted in the testicle and tissue/sperm are aspirated. Occasionally, TESA doesn’t provide enough tissue/sperm and an open testis biopsy is needed.
TESE: Testicular Sperm Extraction
TESE involves making a small incision in the testis and examining the tubules for the presence of sperm. It is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval. TESE is usually performed in the operating room with sedation, but can be performed in the office with local anesthesia alone. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. MicroTESE has replaced this as the optimal form of retrieval for men with no sperm in their ejaculate (azoospermia) from a problem with production.
microTESE: Microdissection Testicular Sperm Extraction
MicroTESE is a procedure performed for men who have a sperm production problem and are azoospermic. MicroTESE is performed in the operating room with general anesthesia under the operating microscope. MicroTESE is carefully coordinated with the female partner’s egg retrieval, and is performed the day before egg retrieval. This allows for each partner to be there for the other’s procedure. Patients frequently have donor sperm backup in case sperm are not found in the male partner. MicroTESE has significantly improved sperm retrieval rates in azoospermic men, and is a safer procedure since less testicular tissue is removed. Patients cryopreserve sperm during this procedure for future IVF/ICSI.
PESA: Percutaneous Epididymal Sperm Aspiration
PESA is a procedure performed for men who are having sperm retrieved for IVF/ICSI who have obstructive azoospermia from either a prior vasectomy or infection. It is done with local anesthesia in the operating room or office and is coordinated with their female partner’s egg retrieval.
MESA: Microepididymal Sperm Aspiration
MESA is a procedure performed for men who have vasal or epididymal obstruction (s/p vasectomy, congenital bilateral absence of the vas deferens). It is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval. MESA is performed in the operating room with general anesthesia utilizing the operating microscope. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. MESA allows for an extensive collection of mature sperm as compared to aspiration techniques, and it is the preferred method of retrieval for men with congenital bilateral absence of the vas deferens as it does not impact steroid production of the testis.
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