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Sperm Aspiration Techniques for Treating Male Factor Infertility

For a couple trying to conceive, a diagnosis like azoospermia (no sperm in ejaculate) or oligospermia (low concentration of sperm in ejaculate) can be very devastating. Fortunately, there are technologies available to help retrieve sperm to be used in an in vitro fertilization (IVF) cycle with intracytoplasmic sperm injection (ICSI).

Hugh Melnick, M.D., Medical Director of Advanced Fertility Services in New York City says procedures like Microsurgical Epididymal Sperm Aspiration (MESA), Percutaneous Epididymal Sperm Aspiration (PESA), and Testicular Sperm Aspiration (TESA) allow urologists and fertility doctors to work together to obtain even a small amount of sperm from testicular or epididymal tissue. “These procedures are ideal for men who have no sperm production in the testes, who have a blockage where sperm can not get out to mix with seminal fluid, for men with a congenital absence of the vas deferens or infection, or those who have had a vasectomy but decide they would like to have a child.”

  • PESA. In PESA, a butterfly needle is inserted into the epididymis to aspirate sperm under local anesthesia. Vasectomy patients are the strongest candidates for PESA.

  • MESA. MESA involves sperm aspiration through a small gage needle inserted into the epidydmis via the scrotum under local anesthesia. Urologists examine any fluid obtained through MESA to extract live, moving sperm. Men with little or no sperm in their ejaculate are candidates for MESA.

  • TESA. TESA is an open surgery under general anesthesia which requires a urologist to remove testicular tissue believed to contain pockets of sperm. Men with little or no sperm in their ejaculate are candidates for TESA. Because TESA is a more invasive procedure, there is a longer recovery time and greater expense.

Michael Jacobs, M.D. of Fertility & IVF in Miami, Florida explains: “With TESA, a urologist trained in techniques for opening the testicle, identifies the microtubular system, and goes through the parts of the testicle like a search and rescue at sea. The urologist must create a grid of the testicle and take layer by layer of tissue hoping to find a pocket of sperm to be used in IVF with ICSI,” says Jacobs.

PESA and MESA can be performed as exploratory procedures before moving on to donor sperm. For some male factor infertility conditions, it has been proven that sperm taken from the testes results in a higher fertilization rate. “It is hard to diagnosis if a man has sperm in his testes or not. We can test FSH and LH, but it isn’t as indicative as with women. If a man’s testes feel soft and large, he is likely to have sperm present,” Melnick states.

While these procedures are most often performed in a urology office, fertility doctors and embryologists are able to team up with a urologist on short notice to perform the procedure in the fertility clinic. “In cases where we are not sure if there is sperm, we can do the aspiration in our office so we have the embryologist on hand to decide when to stop and when to go. If we know there is sperm, it can be aspirated in the urology office, ideally on the same day,” says Jacobs. In instances where a couple is present in at the clinic on the day of egg retrieval and the male partner is unable to provide an ejaculated sperm sample, a urologist can retrieve sperm using PESA in-office. He continues: “For men with erectile dysfunction, stress, or those who are older, we recommend a backup sperm sample. If they do not want to provide a backup sperm sample, we need to use PESA as a bail out for the rare case that the male is unable to perform.”

Patients with male factor infertility are advised to consider the back-up option of donor sperm in case aspiration does not yield the desired results. “We always get the eggs first to make sure we can get eggs and we also talk about the option of donor sperm as back up. If we can’t obtain sperm and the patient does not want to use donor sperm, we can freeze the eggs and make another attempt at biopsy,” says Melnick.


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