SURGICAL SPERM EXTRACTION

Testicular biopsy can be part of intracytoplasmic sperm injection (ICSI) treatment in patients with clinical evidence of NOA(Nonobstructive Azospermi).

Where to begin

Surgical Sperm Extraction (Micro TESE,TEST, TESA, PESA)

Testicular biopsy can be part of intracytoplasmic sperm injection (ICSI) treatment in patients with clinical evidence of NOA(Nonobstructive Azospermi). Testicular sperm extraction (TESE) is the technique of choice. Spermatogenesis may be focal, which means that in about 50% of men with NOA, spermatozoa can be found and used for ICSI. Most authors, therefore, recommend taking several testicular samples. There is a good correlation between the histology found upon diagnostic biopsy and the likelihood of finding mature sperm cells during testicular sperm retrieval and ICSI. However, no threshold value has been found for FSH, inhibin B, or testicular volume and successful sperm harvesting. When there are complete AZFa and AZFb microdeletions, the likelihood of sperm retrieval is virtually zero. Microsurgical TESE increases retrieval rates vs. conventional TESE and should be preferred in severe cases of non-obstructive azoospermia. Positive retrievals are reported even in conditions such as Sertoli cell-only syndrome type II. 

The results of ICSI are worse when using sperm retrieved from men with NOA compared to sperm from ejaculated semen and from men with obstructive azoospermia (OA). Birth rates are lower in NOA vs. OA (19% vs 28%). 

ICSI results in significantly lower fertilization and implantation rates. 

Neonatal health in terms of birth parameters, major anomalies, and chromosomal aberrations in a large cohort of children born after the use of non-ejaculated sperm is comparable to the outcome of children born after use of ejaculated sperm. 

WHAT IS MICROTESE?

Microsurgical testicular sperm extraction (microTESE) is a surgical procedure used to retrieve sperm from the seminiferous tubules of a male’s testes. It’s used for men with non-obstructive azoospermia, which is when a man cannot produce enough sperm to have a detectable amount in his semen — a common cause of male infertility. Doctors will usually recommend microTESE in these cases:

  • If a man has an adequate level of testosterone in his blood after a hormone test and has other exams indicating that his testicles are not making normal amounts of sperm.
  • If a man remains azoospermic even though he has received treatment and his testosterone levels have been normal for at least four months.

The microTESE success rate is quite favorable for men. In fact, doctors are able to find sperm approximately 60 percent of the time during microTESE procedures.

WHAT IS TESA?

A procedure in which a sample of sperm cells and tissue are removed from the testicle through a small needle attached to a syringe. The sperm is separated from the tissue and looked at under a microscope in the laboratory. It may then be used right away to fertilize eggs or frozen for future infertility treatment. Testicular sperm aspiration may be useful for men who have fertility problems caused by a blockage that keeps sperm from being ejaculated. This could be caused by previous vasectomy, certain genetic conditions, ejaculation problems, infection, or other conditions. It may also be useful for men who want to have children after having treatment that may cause infertility, such as certain cancer treatments. Testicular sperm aspiration is a type of sperm retrieval method. Also called TESA.

WHAT IS PESA?

PESA is a procedure that can be performed under local anesthesia without a microsurgical skill set. The procedure involves placing a butterfly needle into the head of the epididymis after administration of the local anesthetic. Negative pressure is applied until a milky white fluid is visualized. The tubing is then clamped and the system is flushed with sperm media into a collection tube. The procedure can be repeated until sufficient yield is obtained. The percutaneous approach obviates the need to perform a skin incision, therefore, avoiding the associated morbidity such as infection and pain; however, a small risk of hematoma is still present. A percutaneous puncture can cause epididymal obstruction due to scarring which may preclude future reconstruction if this is pursued. PESA sperm yield is lower than MESA although usually, sperm numbers are adequate for ICSI.