Sperm Extraction Techniques

What Is It?

Surgical procedures which can be used to extract sperm from a male whenever ejaculation through the penis is not possible.

Types of Procedure

Microsurgical epididymal sperm aspiration (MESA), Percutaneous epididymal sperm aspiration (PESA), Testicular tissue sperm aspiration (TESE)

In use since

MESA - reports of its use as early as 1984, but first live birth resulting in 1990

Indications

MESA

  • cases of congenital absence of the vas deferens (the long tube through which sperm travel during ejaculation)
  • some cases of vasectomy or failed reversal (vasovasotomy)

PESA

  • irreparable obstruction resulting in azoospermia
  • congenital absence of the vas deferens
  • vasectomies or failed vasectomy reversals

TESE

  • absence of the vas deferens
  • non-obstructive azoospermia

How It Works

Sperm are aspirated from the male epididymis or acquired from surgically-removed testicular tissue for use in ICSI or to be cryopreserved.

Success Rates

Pregnancy rates range from a low of mid-20% for PESA and testicular biopsy to 40% for TESA to a high of 80% for MESA. In cases of obstructive azoospermia, cryopreserved sperm can achieve fertilization rates similar to fresh sperm. In cases of non-obstructed azoospermia, fresh sperm is preferable. Of the various extraction techniques, the most successful combination thus far is MESA with ICSI, with fertilization and pregnancy rates up to 45 and 52 percent, respectively.

Typical Procedure Protocol

MESA

  • patient is generally anesthetised
  • access to the testis is made through a midline scrotal incision
  • the obstructed epididymis is punctured at specific locations
  • seminal fluid is aspirated using a pipette
  • fluid is examined by IVF team immediately to assess sperm characteristics (count and motility)
  • if deemed necessary, more fluid may be extracted at this time
  • satisfactory fluid samples are taken to IVF lab where they are 'washed' to remove debris, macrophages, and blood products

PESA

  • patient is generally or locally anesthetised
  • a 21-guage needle attached to a syringe is inserted into the epididymis
  • seminal fluid is withdrawn through the needle, and the procedure repeated until satisfactory amounts are obtained
  • If no sperm is retrieved through PESA (which occurs in approx 20% of attempts), it is necessary to proceed to the other sperm extraction techniques.
  • Also related: Testicular fine needle aspiration (TESA), in which the needle is inserted directly into the testis

TESE

uses testicular tissue retrieved through several different manners:

  • Percutaneous biopsy: uses a 14-gauge automatic biopsy gun under local anesthesia
  • Standard biopsy: uses surgical incision through scrotum to access testis and obtain large volumes of tissue samples (Standard biopsy not recommended due to potential for harm to testicular blood supply)
  • Microdissection: uses microsurgical techniques to excise seminiferous tubules

Average Costs, excluding pre-treatment evaluation

  • MESA, TESA, or TESE: US $3,000 to $4,000
  • PESA: US $1500
  • Sperm cryopreservation: US $200

Expected physical effects

  • Mild bruising
  • Discomfort, soreness after procedure

Physical effects to report to your doctor

  • Bleeding more than a small amount from incision/aspiration site
  • Puss or other secretion coming from incision

Precautions/Risks

  • Infection at surgical/aspiration site.
  • Nerve damage.
  • Damage to blood vessels or epididymal tubules.
  • Testicular atrophy (shrinking with loss of function). Very rare.
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