Friday, December 05, 2008

Sperm Aspiration Techniques

Ten percent of men have no sperm in their ejaculates, yet with modern fertility procedures they can still have their own, biological children. A urologist that is skillful in the sperm retrieval procedure can locate pockets of healthy sperm in the majority of azoospermic (no sperm) men. There are a number of different approaches that the urologist can take. These include:
  • mTESE--or the microTESE. In this technique, the urologist uses the aid of a high power operative microscope to locate normal looking sperm ducts within the testicle. Success rates are high, but this approach requires special equipment that many IVF centers do not possess, is very invasive, and can result in significant post-op swelling and soreness.
  • TESE Mapping. In this method, the urologist samples geographic regions of the testicle with multiple needle biopsies looking for sperm. When sperm is found, a larger specimen is taken from that area. Success rates are good with this approach as well, but it is time consuming, invasive, and requires that the man have multiple operations.
  • The fresh TESE. This is the most common approach and involves coordinating the TESE with the woman's fresh egg retrieval and IVF-ICSI cycle. With a fresh TESE, sperm does not need to be frozen, the man needs only one procedure, and success rates are very high. The downside is that couples only learn whether or not the TESE was successful in finding healthy sperm until after they have already committed large sums of money, energy, and emotion to the IVF process.
  • The needle TESE. In this approach, the urologist simply places a needle into tubules within the testicle, aspirates backwards, removes tubules, and hopefully finds sperm. The advantage of this approach is that it is very non-invasive, truly painless, and it allows for very quick recovery. The disadvantage is that success rates are poor for men with disorders of sperm production, as opposed to obstruction or blockages, like after a vasectomy. For men who have had vasectomies but wish to have another baby with IVF, the needle TESE is a great option.
  • The Doppler-Sono TESE. This is a relatively new modification to the TESE procedure. It involves using high resolution color Doppler ultrasound to image the testicle itself and identify regions within it that may contain sperm. Such regions will have increased vascularity and enlarged tubules that can be seen on the sonographic image. A skinny needle is then placed under ultrasound guidance into these areas, tubules containing sperm are removed, and the sperm is the used for IVF-ICSI. In essence, the Doppler-Sono TESE combines the success rates of the microTESE with the non-invasive, painless, and recovery characteristics of the needle TESE.
Which TESE procedure is right for you and your partner will depend on a number of factors.
These factors will be discussed in a future post.

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