What is a sperm retrieval?

Watch the video below and find out.  

http://youtu.be/FTHsoRvFIzc

This is big!

From the journal of urology:

Successful Fertility Treatment for Klinefelter's Syndrome
Ranjith Ramasamy, Joseph A. Ricci, Gianpiero D. Palermo, Lucinda Veeck Gosden, Zev Rosenwaks, Peter N. Schlegel

Microdissection testicular sperm extraction is an effective sperm retrieval technique in men with Klinefelter's syndrome. Men with hypogonadism who respond to medical therapy may have a better chance of sperm retrieval.

An unsuccessful TESE

Most of the time, it is possible to find pockets of sperm production in the testicle of a man who has no sperm in the ejaculate. This can be accomplished through a procedure known as a TESE; a testicular sperm extraction.

But sometimes, as in this patient, there is just no sperm, as can be seen in the images above.

His options for continued treatment are to repeat the procedure, donor sperm and IUI, or possible the microTESE. The microTESE is a procedure performed by very few male infertility specialists that conbines the standard TESE with the aid of an OR miroscope. Success rates can be increased in select patients and cases.

A nice technique for Testicular Sperm Extraction.

I like this technique for testicular sperm extraction. I do it in my Smithtown Long Island office.

Dr S

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.

If you would like to learn more, submit the form to the side of this page.

Thanks,

DrS

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