Treatments

Male Infertility

Surgical sperm retrieval includes a series of procedures specially designed to help remove and retrieve sperm in men with very poor semen sample, who can not obtain a semen sample or have no sperm in the semen (azoospermia).

Surgical Sperm Retrieval
Surgical sperm retrieval includes a series of procedures specially designed to help remove and retrieve sperm in men with very poor semen sample, who can not obtain a semen sample or have no sperm in the semen (azoospermia). Once collected, the sperm must be frozen for its posterior use in assisted reproduction techniques such as intracytoplasmic sperm injection (ICSI), thus avoiding future interventions.

What Is Surgical Sperm Retrieval?
Surgical retrieval of sperm is a treatment to improve fertility. It includes surgical methods, which must be used to obtain sperm from the body of men who can not produce it naturally. Unlike other treatments, by means of this particular procedure sperm will be extracted directly from the testis or epididymis, rather than waiting for the sperm to be obtained through ejaculation.

Once the extraction of sperm has been performed, it can be used in assisted reproduction techniques such as intracytoplasmic sperm injection (ICSI). About 10% of men with infertility problems produce seminal fluid that seems to have no spermatozoa. This could be the result of a number of factors, namely: an obstruction or blockage in the vas deferens, and these are the tubes that carry sperm from the testicles to the exterior; a total absence of these tubes; or an obstruction or blockage of the epididymis, which is the body responsible for connecting the vas deferens to the testicles. Most of these men are capable of producing healthy sperm inside their testicles, but despite this, they must be extracted using these techniques. On the other hand, there are other men who have healthy testicles but are unable to produce sperm. This disability or medical condition is known as AZOOSPERMIA and we can also find sperm in these patients through sperm recovery techniques.

Types of Surgical Sperm Retrieval
Currently there are a number of different types of surgeries specially designed for sperm retrieval. The most appropriate technique is selected depending on the factor that could be causing the sperm absence in the semen. Some will be more effective than others. But above all, the effectiveness of the treatment depends on the type of fertilization method chosen to successfully conceive a baby.

  • Percutaneous Sperm Aspiration (PESA): Usually PESA is the first choice of treatment, in the event your semen has no sperm. It is a brief and relatively painless procedure, as it requires no surgical incisions or cuts. To carry out this procedure a needle is used which is inserted through the scrotum to reach the epididymis. The fluid contained therein will be removed very slowly and gradually through an aspiration process using a special needle. This fluid will then be analyzed in our assisted reproduction laboratory to verify their sperm count and spermatozoa motility. Usually, this procedure will take 20 to 30 minutes and only requires local or spinal anesthesia.
  • Microepididymal Sperm Aspiration (MESA): It is a microsurgical treatment requiring general anesthesia or spinal anesthesia. It is necessary to take into account that instead of using a needle, a small incision through the scrotum will be done to reach the epididymis, using a microsurgical instrument. Any fluid that may be present therein will be drained and be subjected to a further microscopic analysis.
  • Testicular Sperm Extraction (TESE): If not a trace of sperm in the epididymal fluid is found, a needle will be inserted into the testicles. This needle or syringe will extract a small tissue sample, which will later be examined in order to detect the presence of sperm.
  • Testicular biopsy: Consists of making a small incision in the testicles and draw some random samples of testicular tissue which will be analyzed in our assisted reproduction laboratory to find sperm that can be used to fertilize the eggs obtained. This particular procedure requires general or spinal anesthesia and could cause mild discomfort and some pain. However, full recovery can usually be accomplished within three days after undergoing this procedure.

Spermatozoa found using these techniques must be frozen for later use in assisted reproduction techniques. When freezing spermatozoa future interventions shall not be necessary.

Possible Complications
Surgical retrieval of sperm is a procedure relatively free from any risk or danger. However, you should take into account that it is really important that you turn to a specialist in these techniques, who has performed this kind of surgery on more than one occasion. Among the main risks arising from this procedure are the following: bleeding or hemorrhage and infection, but it is estimated that only 3% of patient may experiment this problems. Any procedure that requires anesthesia could lead to an increased risk of suffering some kind of complication.

Efficacy of Surgical Sperm Retrieval
Surgical sperm retrieval success rate varies depending on the type of procedure chosen and undergone by the patient. Since the sperm is extracted from inside the body, it may not be mature enough, therefore, will require ICSI in order to normally fertilize the eggs obtained.

The intracytoplasmic sperm injection (ICSI) is one of the assisted reproduction techniques that use spermatozoa obtained from sperm retrieval techniques. The PESA is directly associated with high retrieval rates between 80% and 90%. The TESA success rates are much lower, and only in 40% to 60% of the patients sperm can be retrieved.

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