Sperm retrieval procedures for assisted reproduction
A potential treatment option for some couples where the male partner is azoospermic (no sperm in the semen) is in vitro fertilization. As part of the treatment plan for men who have an obstruction, a sperm retrieval procedure is usually scheduled in conjunction with the female partner's cycle. Dr. Shin works with many of the top reproductive endocrinologists on the area to provide the best sperm for IVF.
There are several different ways to access the testicles and surrounding collecting system for sperm for IVF.
PESA (Percutaneous Epididymal Sperm Aspiration)
This is a quick and reasonably non-invasive procedure to harvest sperm from men with congenital or acquired blockages of the vas deferens. A small caliber needle is gently guided into the epididymis and sperm are aspirated. This procedure is usually performed under a mild sedative and local anesthetic. The benefit is that it is reasonably fast, a potential negative is that usually only enough sperm for one cycle of IVF can be obtained.
The recovery from this is quite quick as local anesthesia is usually employed, with a return to normal activity and work within 24 hours.
MESA (Microsurgical Epididymal Sperm Aspiration)
This is more invasive than the percutaneous approach. Done under general anesthesia, a MESA involves a small incision to access the epididymis and then, with the assistance of the operating microscope, the epididymal tubules are drained and aspirated.
The advantage of this type of harvest is that for one procedure, multiple vials of sperm, usually enough for several IVF procedures, are obtained. Because a general anesthetic and a small incision are used, the recovery period for this procedure tends to be a bit longer. Generally 2-3 days off and a week of light activity are all that is required. Heavy lifting and vigorous physical or sexual activity should be avoided for about a week.
Similar to a MESA, a testis biopsy involves some light sedation and a small incision to get a piece of testis tissue. This is the preferred approach in patients that have non-obstructive azoospermia or severe oligospermia. The recovery period and precautions are similar in scope and duration for a MESA.
Performing a testis biopsy may also be done as a diagnostic maneuver to delineate the architecture of the testicle as well as gauge the level of sperm production and extent of maturation.
An open testicular biopsy. A small incision about 1 cm in length is made.
An artistic rendition of a percutaneous aspiration of the epididymis.
A high-power magnification view of an obstructed epididymis. Notice the tortuous tubules present. During a MESA, sperm is drained and aspirated from these tubules.
Photographs (c) Dr. Anthony Thomas