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Tuesday, June 1, 2010
Male Infertility

By Marc Goldstein, M.D., F.A.C.S., Cornell Institute for Reproductive Medicine

We perform and, in fact, are pioneers in sperm aspiration here at The New York Presbyterian Hospital-Cornell Medical Center. Sperm aspiration involves extraction of sperm from either the ducts leading out from the testicle (vas deferens or epididymis) or from the testicle itself. Sperm obtained by aspiration can only be used for in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This is because aspirated sperm in men who are blocked do not swim well and will not fertilize the egg unless the sperm is injected directly into the egg (ICSI). For men undergoing microsurgical vaso-vasostomy on at least one side, we usually do not recommend aspiration of sperm at the time of the surgery because our success rate for return of sperm in the semen after vaso-vasostomy is 99.5%. If a vaso-epididymostomy is necessary on both sides however, the success rate drops to 80% for return of sperm. Therefore in all men undergoing only vaso-epididymostomy, we recommend the aspiration and freezing of sperm in the operating room at the time of surgery. This will allow sperm to be available for future IVF in the event that the surgery to repair the blockage is not successful.

Sperm aspiration may be performed instead of vasectomy reversal. We usually do not recommend this as the primary treatment, because it also requires the wife to go through an IVF procedure. This requires daily hormone injections for 30 days, at the end of which time the wife undergoes sonograms on a daily basis to determine when the follicles are ripe. When the follicles are ripe, the wife is brought into the hospital and either put to sleep or given heavy sedation. The eggs are then removed through the vagina with long needles. The sperm that was aspirated are injected directly into the egg. If the eggs fertilize, three or five days later they are transferred back into the wife with a plastic catheter. Currently the cost of the IVF with ICSI is $15,000 for each attempt. This does not include the cost of aspirating sperm from the man. A single attempt yields approximately a 45% chance of taking home a baby if the wife is under 35. This procedure must be repeated for each attempt at pregnancy and for each future pregnancy.

Because the reversal of vasectomy yields pregnancy rates between 50% and 70% with natural intercourse, we usually recommend sperm aspiration as a secondary procedure. That is, if sperm are present in the semen after the reversal operation, but the wife is not getting pregnant, then IVF with ICSI can be employed using sperm from the semen of the man without him requiring another operation. By performing a vasectomy reversal and if necessary, sperm aspiration simultaneously, all bets are covered.

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