Advances in Assisted Reproductive Technique, offered by Georgia Urology Center for Male in Atlanta metro area, now allows pregnancy to occur with very few sperm. This is done through IVF/ICSI or In Vitro Fertilization with Sperm Extraction and Aspiration.
Men Who May Require IVF/ICSI to Father Children Are:
- Men with reduced sperm production with extremely low (severe oligospermia) or no sperm in the semen (non obstructive azoospermia).
- Men with normal sperm production but obstruction or absence of the genital ducts (obstructive azoospermia) preventing sperm from reaching the ejaculate. This group includes men who had vasectomy or had failed vasectomy reversal.
How is Sperm Extracted?
For Men with Non-Obstructive Azoospermia (NOA)
- Testicular sperm extraction or TESE: A small incision is made on the scrotum through with small testis tissue samples are taken and submitted to the lab for extraction.
- Micro-TESE: Surgical procedure in which a microscopic is used to magnify the testicular tissue prior to tubule removal. Sperm containing tubules have a different appearance when examined under high magnification; this difference allows for selective removal of only sperm-containing tubules and avoids removal of tissue devoid of sperm.
In Men with Obstructive Azoospermia (OA), More Options Are Possible:
- Percutaneous Epididymal Sperm Aspiration or PESA
- Testicular Sperm Aspiration or TESA
- Testicular Sperm Extraction or TESE
- Microscopic Epididymal Sperm Aspiration or MESA
PESA and TESA are similar procedures. A small needle is placed in the epididymis or testis, suction is applied and a small number of sperm are obtained. Both are easily performed in the office under local anesthesia.
TESE is identical to the procedure outlined for men with NOA except that large number of sperm is easily obtained for either immediate use or cryopreservation.
MESA is similar to micro-TESE in that it is an operating room procedure. The engorged epididymis is examined under an operating microscope and the epididymal fluid laden with sperm is then collected for either immediate use or cryopreservation.
The common denominator of all of the procedures is that the sperm retrieved are functionally immature and small in quantity when compared to a normal ejaculate. Although these sperm are quite capable of fertilization and achieving normal pregnancy, they do not have the ability to penetrate eggs on their own and thus IVF/ICSI is necessary to initiate fertilization.