Sperm Retrieval Techniques
Non Surgical Sperm Aspiration
a.Testicular Sperm Aspiration -TESA
In TESA performed in our clinic under local Anesthesia , one
can easily and quickly obtain adequate numbers of sperm for
ICSI in many men who have no sperm in their semen because
or other causes
of blocked ducts; in men who cannot ejaculate including men
with spinal cord injury.
Men who lack living sperm in their ejaculate frequently have
at least some sperm in the testicles, where sperm are made.
Testicular sperm can fertilize if they are injected directly
into the eggs through a process called ICSI (Intracytoplasmic
TESA is performed under sedation, and is painless and rapid.
A tiny needle is used to extract sperm directly from the testis.
While the ejaculate normally contains 100 million to 300 million
sperm, aspiration of as few as 100-200 sperm by NSA have been
enough to achieve pregnancy when it is combined with ICSI.
Prior to the development of TESA, men with no sperm in their
ejaculate had to undergo surgery to remove sperm either from
their testes or from tubes connected to the testis. Non-surgical
sperm aspiration is rapid, does not require hospitalization,
is pain-free when done under sedation, and recovery is virtually
The technique will be immensely helpful to men who have had
vasectomies and later decide that they want to have children.
It is possible to reverse a vasectomy by having bypass surgery,
but the operation is frequently not successful, especially
for men with long-standing vasectomies. Additionally, sperm
quality after vasectomy reversal is often reduced and ICSI
is required even if sperm appear in the ejaculate.
For many men, non-surgical sperm aspiration eliminates the
need for vas reversal surgery. Men who cannot ejaculate due
to spinal cord injuries or neurological conditions like multiple
sclerosis can also become fathers through the new technique.
There is also a large group of infertile men who simply have
no sperm or only dead sperm in their semen although their
ducts and ejaculatory process are normal, and who can have
testicular sperm obtained through NSA.
b. Percutaneous Epididymal Sperm Aspiration PESA
In this the sperms are directly aspirated with the aid of
a small needle mounted on a syringe. The skin is not cut open
.The aspirate is given to the laboratory, where the sperms
are identified and ICSI is performed. PESA will also help
infertile men who lack sperm in their semen because the route
out of the testes has been blocked by prior infection or congenital
lack of development (Congenital Bilateral Absence of Vas Deferens
CBAVD), as well as men who have had their prostates removed
and can no longer ejaculate but make sperm.
NSA must be done with ICSI because testicular sperm cannot
enter eggs by themselves. The female partner receives a series
of medications to increase the number of eggs created by the
ovary as in a conventional IVF cycle. When the eggs grow to
adequate size, they are extracted non- surgically at the Institute
under sedation, and NSA is scheduled the same day. After egg
retrieval and sperm aspiration, our embryologists will inject
each egg with a single sperm. Two days after the procedures,
definite information regarding fertilization of the eggs and
the number of embryos will be available. Embryos will be transferred
back to the uterus two or three days following fertilization;
additional embryos may be cryopreserved (frozen), as requested.
It should be noted that for some men a single NSA procedure
may yield enough sperm to permit sperm freezing for several
subsequent ICSI attempts.
B. Testicular Sperm Extraction(TESE)
There is a particular group of males who have no sperms in
their semen. Also standard testicular biopsy procedure, done
in the past , have shown no spermatogenic activity. In recent
times, many such males, have undergone the procedure of TESE.
The biopsy specimen thus obtained, has been meticulously searched
for sperms, over 2 to 6 hours, sperms obtained, ICSI performed
and pregnancies achieved. As many as 10 -30% men with established
testicular failure, have fathered kids with this technique.
We at the Babies And Us Fertility Centre are doing all the
above procedures in our lab, with a high pregnancy rate.