SPERM RETRIEVAL PROCEDURES

Common Surgical Procedures for the Treatment of Male Infertility

 

TESTICULAR SPERM EXTRACTION (TESE)

Testicular sperm extraction, known as “TESE,” is a procedure for extracting sperm from one or both testicles for the purposes of reproduction using in vitro fertilization. TESE can be performed by a conventional open surgical approach, or by using a specialized device to extract cores of tissue from one or both testicles. TESE is performed under sedation to improve patient comfort.   Sperm retrieval rates are near 100% in patients who are producing sperm normally but are obstructed (obstructive azoospermia, such as after vasectomy).  In patients with azoospermia due to poor sperm production (nonobstructive azoospermia), sperm retrieval rates using TESE are 25-30%.

 

TESTICULAR NEEDLE ASPIRATION (TESA)

Testicular needle aspiration, known as “TESA,” is a minimally invasive procedure for extracting sperm from one or both testicles for the purposes of reproduction using in vitro fertilization. TESA can be performed under local anesthesia alone, but sedation is often helpful to improve patient comfort during the procedure. A small caliber needle is directed into one or both testicles to extract seminiferous tubular fluid and very small fragments of tissue. TESA is usually an effective procedure for men who are producing sperm normally but are obstructed (obstructive azoospermia, such as after vasectomy).  In patients with azoospermia due to poor sperm production (nonobstructive azoospermia), sperm retrieval rates using TESA are 15-25%.

 

PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION (PESA)

Percutaneous epididymal sperm aspiration, known as “PESA,” is a minimally invasive procedure for extracting sperm from one or both epididymides for the purposes of reproduction using in vitro fertilization. The epididymis is the organ attached to each testicle that stores and matures sperm once they are produced. Epididymal sperm are more mature, more numerous, and often exhibit better motility than testicular sperm. PESA is performed by inserting a small caliber needle directed into one or both epididymides to extract sperm-containing epididymal fluid.  PESA  is usually an effective procedure for men who are producing sperm normally but are obstructed (obstructive azoospermia, such as after vasectomy).  PESA is not an option for patients with azoospermia due to poor sperm production (nonobstructive azoospermia).

 

MICROSURGICAL EPIDIDYMAL SPERM ASPIRATION (MESA)

Microsurgical epididymal sperm aspiration, known as “MESA,”  is an option for sperm retrieval in patients with obstruction after vasectomy, congenital absence of the vasa deferentia (sperm transport tubes), or other variants of obstruction.  MESA is performed under regional or general anesthesia with the aid of an operating microscope, which allows the procedure to be performed under 20-30 power magnification.  The epididymis is surgically exposed and sperm are harvested from precise sites within the epididymis.  MESA typically enables retrieval of hundreds of thousands to millions of motile sperm.   Since MESA requires general anesthesia and is both more invasive and expensive than other types of sperm retrieval procedures, it is only used in selected clinical cases.

 

MICRODISSECTION TESTICULAR SPERM EXTRACTION (MICROTESE)

Microdissection testicular sperm extraction, known as “MicroTESE,” is a procedure for sperm acquisition that is only indicated for men with nonobstructive azoospermia.  It is performed under regional or general anesthesia with the aid of an operating microscope, which allows the procedure to be performed under 20-30 power magnification.  One or both testicles are opened in such a way as to widely expose the seminiferous tubular tissue.  High power optical magnification allows the surgeon to selectively sample the best appearing seminiferous tubules, where sperm are most likely to be found, while minimizing disruption to the testicular blood supply.  Sperm are found in 40-50% of patients with nonobstructive azoospermia using microTESE.