This is a technique used to help couples where the male partner does not ejaculate sperm. A small number of sperm are obtained directly from the epididymis or testicles in a simple surgical procedure sufficient for IVF treatment.
There are various ways in which sperm can be retrieved surgically. Sperm can be retrieved from the epididymis, from the vas deference or directly from the testes. This is usually done when there are no sperm cells in the ejaculate. Occasionally it can also be done when there is unexpected ejaculation failure on the day of egg retrieval. The procedure is carried out under local anaesthesia and after a few minutes rest, the man can usually go home.
How is Surgical Sperm Retrieval performed?
Percutaneous Epididymal Sperm Aspiration (PESA);
- The procedure is usually done under sedation with pain relief, but can equally be done under General Anaesthetic
- In a number of men, sperm can be extracted directly from the epididymis
- A fine needle is passed through the skin of the scrotum and placed in the epididymis
- Small amounts of fluid can be taken and examined for sperm
Testicular Sperm Aspiration (TESA);
- Sperm is extracted directly from the testicles by passing a fine needle directly into the testicle
- A small amount of tissue is extracted and prepared in the laboratory and examined for presence of sperm
Sperm obtained are either frozen for subsequent use or prepared using a process of washing and grading. A single sperm is then injected directly into each egg in a process known as intracytoplasmic sperm injection or ICSI.
Are sperm always obtained using Surgical Sperm Retrieval?
Not all patients are suitable for this technique and occasionally, no viable sperm can be recovered.
Sperm can only be obtained if the man’s testicles are producing sperm. Unfortunately, it’s not always possible to predict this outcome. Hormone tests and examination can help, but a trial biopsy is the sure way to go.
What happens if sperm are obtained?
- Sperm found in the trial biopsy can be frozen for use in a subsequent treatment cycle
- If sufficient, suitable sperm is obtained, treatment can commence
- A test thaw is conducted on a small part of the sample to confirm that the sperm can survive the freezing process
- Surviving sperm can be used in subsequent treatment
- If sperm do not survive the thawing process, Dr. Jude will perform a fresh procedure at the same time as egg collection, during treatment.
Generally, PESA sperm can be frozen and thawed in the majority of cases, but TESA sperm does not freeze well.
What happens if sperm are not obtained?
If no sperm are found in the biopsy, IVF with ICSI will not be suitable. We will discuss all your options and alternatives including Donor Insemination in the hospital.
What happens in a PESA/TESA treatment cycle?
A PESA or TESA treatment cycle will involve the women undergoing a standard stimulated IVF cycle where the ovaries are stimulated to produce multiple eggs.
Frozen sperm samples are simply thawed and prepared on the day of egg collection or a fresh sperm sample will be obtained around the time of egg collection if required.
Are any tests required before treatment?
Investigations are required to help predict whether sperm can be obtained at the biopsy and for the presence of any condition that might cause problems in children born from the procedure.
- Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH) and Testosterone are measured
- Very high FSH and LH and low Testosterone suggest testicles are not functioning well and chances of obtaining sperm are lower
- If the testicles are very small, the chances of obtaining sperm are lower
- Conditions such as Congenital Absence of the Vasa Deferens may be identified by examination
- Some men will not produce sperm due to chromosome abnormalities
- This may not cause any problems other than sperm production but could cause problems for children
- It is very important we always check the man’s chromosomes before the biopsy
Y chromosome mircodeletion test
Cystic Fibrosis testing:
- One in every 25 people carry this gene, but it is more common in men who have absent vasa deferens
- If their partner also carries the gene, it increases the chance of the child being affected
- If the man has the gene, we then test his partner. Treatment can continue if she is negative
- Genetic counselling and support is available for positive tests
HIV and Hepatitis:
- All individuals storing sperm, eggs or embryos are screened for HIV and hepatitis B and C
- This rules out any chance of cross contamination in the laboratory and in embryo storage vessels
The female partner will also need to undergo fertility investigations before IVF treatment including;
- Hormone tests during the menstrual cycle to ensure that she is able to produce eggs
- Tests to check the womb
- Further investigations may be required in the clinic and will be fully discussed with you
What happens on the day of the Surgical Sperm Retrieval?
- A PESA procedure is performed to see if sperm are present
- If no sperm are found in the epididymis, a testicular aspiration (TESA) will be performed
- You may experience some mild discomfort following the procedure, which should be relieved by simple painkillers like Paracetamol
- We advise supportive underwear and loose trousers be worn until the discomfort is gone