Microsurgical Sperm Extraction

Microsurgical Sperm Extraction

  • Male factor infertility contributes to 1/3 rd of the problem faced by infertile couples.
  • Semen abnormality can be in the form of less count (Oligospermia), poor motility (Asthenozoospermia) or Abnormal morphology (Teratozoospermia)
  • Even a very small number of sperms obtained in a semen sample can be used for fertilization by ICSI (Intracytoplasmic sperm injection).
  • The difficulty arises when semen sample contains no sperms (Azoospermia)It can be due to:
1) Obstructive Azoospermia

Blocked tubes (vas deference) transporting sperms from testes to the penis.

2) Non-obstructive Azoospermia
  • No obstruction in the passage of sperms however due to genetic abnormality release of sperms outside testes is prevented
  • Microsurgical technics involve aspiration or extraction of sperms from testes or obstructed tubes to be used for fertilization via ICSI

Surgical Retrieval:

In the presence of Obstruction

When a release of sperms is prevented by obstruction to vas deference or vasectomy, sperms can be retrieved from obstructed tubes under local anaesthesia via needles or tubes inserted through the skin.

Microsurgical Sperm Extraction

TESA (Testicular Sperm Aspiration )

This involves aspiration of sperms containing fluid from testes via a needle attached to the syringe. It is passed through the skin of scrotum under local anaesthesia

PESA (Percutaneous Epididymal Sperm Aspiration)

Needle with syringe is placed directly in the epididymis to aspirate sperm-containing fluid.

Perc biopsy (Percutaneous Biopsy of the Testis)

Percutaneous biopsy of the testis Procedure is similar to TESA however larger bore needle is used to extract the number of sperms from testes

MESA (Microsurgical Epididymal Sperm Aspiration)

Microsurgical epididymal sperm aspiration. This involves an open surgical procedure in which a microscope is used to identify the tubules of the epididymis. Sperms can be retrieved from tubules in large quantity. Studies indicate MESA gives the highest number of motile sperm as compared to other retrieval procedures. Results in ICSI are better with sperms retrieved through MESA.

• In Absence of Obstruction

In the absence of tubular obstruction, azoospermia is due to problems in the process of sperm production.

TESE (Testicular Sperm Extraction)

Testicular tissue is obtained through a small incision. The tissue is examined under a microscope to identify sperms or precursors.

Microdissection TESE

Principle and procedure are similar to TESE. Microdissection microscope is used to determine tissue to be removed. This causes less dissection and less damage to the blood supply to the tissue. Sperm yields obtained is better than open TESE.

This microsurgical retrieval technics have revolutionized the treatment of infertile couples with absent sperms making ICSI possible to help them to have own babies.