TESE Technique for post blockage/vasectomy sperm retrieval

Some urologists asked me how I do a TESE. Here's a step by step:

• perform a perivasal cord block
• grasp the testicle so that the scrotal skin is held taught
• infiltrate the skin and dartos with the local
• make an incision through the skin and deepen it to expose the testicle within the tunica vaginalis (TV) sac
• excise in to the TV to expose the testicle
• place a 4-0 monocryl into the upper pole of the testis
• incise into the tunica albuginea (TA) of the testicle with the beaver blade
• remove some tubules and place them un media
• Wet prep of some sort to look for sperm present or absent and motility
• Hemostasis with bipolar as needed
• close the TA with the monocryl
• repeat above procedure as needed to find good quality sperm
• replace testicle to usual anatomic location, if necessary
• close TV and dartos with 3-0 chromic
• close dartos and skin with 4-0 monocryl
• dermabond and steris on skin

That's how the pros do it. Need one or know someone that does:

http://www.drschoor.com

An Open Ejaculatory Duct.

Nice Image minutes after a TUR-ED (Transurethral resection of the Ejaculatory Duct).

Can hernia repairs cause infertility?

The answer is yes.  Hernia repairs can result in damage to the vas deferens, the tube that carries sperm from the testicle to the outside world. 

How often this happens is not clearly known because:

• Most hernias are unilateral, ie one sided only.
• People who have hernia repairs are often beyond their child bearing years.
• We don't routinely test sperm counts after hernia repairs.

Most hernia repairs are performed using a mesh that makes the hernia repair very strong and the patient's recovery pain free.  The reason that mesh is so good for hernia repairs is that it produces a very dense inflammatory reaction in the region of the hernia and the resultant scar prevents hernia recurrence. 

The inflammatory reaction also can damage the vas deferens.  More rarely, the vas can be injured by an errant clip or suture placement during the procedure. 

In any case, when I see a patient with azoospermia--no sperm--and 2 scars in their inguinal canals--groins--I think blockage.

Patients with azoospermia from hernia-induced blockages can be effectively treated.

A non-invasive sperm retrieval technique

Some men do not have sperm in their ejaculates, a condition known as azoospermia.  Azoospermia can be caused by a blockage, such as after a vasectomy or hernia repair, or as a result of sperm production disorder within the testicle.  In either case, it is often possible for the urologist to locate sperm of sufficient quantity and quality to fertilize an egg.

Men with production disorders typically have very few sperm within their testicles.  While it is possible to locate this sperm, it is not easy to do so and these men need a type of sperm retrieval procedure called the TESE. TESEs are somewhat invasive surgical procedures, but in men with severe disorders of sperm production, they are the only option for a couple who wants to use the patient's own sperm to reproduce.

The treatment of men with blockages can be much more straightforward. Essentially, the urologist can fix the blockage or the couple can proceed directly to assisted reproduction in the form of in-vitro fertilization, intracytoplasmic sperm injection (ICSI), or artificial insemenination (IUI) and the urologist can do a sperm retrieval.  In cases of known blockages, the sperm retrieval can often be accomplished under local anesthesia with a small guaged needle and a bandaid. 

Here's how it works:

1. I discuss the options, risks, and success rates with you for all the forms of sperm retrievals and recommend the approach that will maximize success and minimize discomfort.  
2. We then coordinate schedules so that the sperm retrieval is performed on the same day as your wife's egg retrieval.
3. Using a small instrument, I can make the entire spermatic cord numb.
4. I then pass a small guaged needle into the body and tail of the epididymis and aspirate back while I apply gently pressure to the epididymis.  
5. When fluid enters the tubing, I withdraw the needle and squirt the fluid into the media, which is then handed off to the embryologist.

And that is it.  The whole process can take 10 to 15 minutes and you will leave with only mild discomfort or soreness.

Typically, enough sperm can be found for the IVF cycle and to freeze any extra.  Rarely, I can obtain enough sperm for IUI.  I do not recommend as a general principle that sperm harvested by a needle approach be used for IUI.

If you have any questions, please feel free to contact me via my website:  www.drschoor.com