If you plan to undergo in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI), you will need to first undergo a sperm retrieval procedure.
Sperm Retrieval Procedures: Expert Care in Maryland
Dr. Karen Boyle has years of experience performing these procedures. She combines her skill and experience with a compassionate approach. Dr. Boyle will work with you every step of the way and answer any questions you may have.
Learn more about Dr. Karen Boyle.
Sperm Retrieval Procedures
There are a number of different procedures available to retrieve sperm for IVS or ICSI. These include:
- Testicular sperm aspiration (TESA)
- Testicular sperm extraction (TESE)
- Microsurgical/microdissection testicular sperm extraction (Micro TESE)
- Percutaneous epididymal sperm aspiration (PESA)
- Microepididymal sperm aspiration (MESA)
TESA: Testicular Sperm Aspiration
Testicular sperm aspiration (TESA) is a procedure performed for men who are having sperm retrieved for in-vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI). It is done with local anesthesia and sedation in the operating room or under local anesthesia alone in the office and is coordinated with your female partner’s egg retrieval. We insert a needle in the testicle and aspirate the tissue/ sperm. TESA is performed for men with obstructive azoospermia (s/p vasectomy or congenital bilateral absence of the vas deferens). Sometimes, TESA doesn’t provide enough tissue/sperm and an open testis biopsy is needed.
TESE: Testicular Sperm Extraction
TESE, testis biopsy and testis mapping are procedures performed for men who have testicular failure. The procedure is performed to see if there are sperm present as well as for pathologic diagnosis to evaluate for causes of abnormal testicular function or malignancy. It is done either as a scheduled procedure or is coordinated with the female partner’s egg retrieval. TESE is usually performed in the operating room with sedation, but can be performed in the office with local anesthesia alone. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. This diagnostic biopsy is usually used to evaluate for an obstructive etiology. Testicular mapping is when multiple biopsies are taken and “mapped” from the upper, middle and lower portion of the testicle. Microdissection TESE has replaced this as the optimal form of retrieval for testis failure patients with genetic abnormalities, severe failure, or failure from systemic therapies such as chemotherapy or radiation.
Microscopic or Microdissection Testicular Sperm Extraction (TESE) is a surgical procedure performed in the operating room under general anesthesia to retrieve sperm for IVF/ICSI. Microdissection TESE can improve sperm retrieval for men with non-obstructive azoospermia over those achieved previously with standard testis biopsy techniques.
Dr. Boyle uses an operating microscope to visualize blood vessels under the surface of the tunica albuginea, the outside layer of the testis. This allows for placement of the dissection to occur in bloodless regions of the testis.
Instead of planning for multiple biopsies, a large incision is made in the midportion of the tunica albuginea to optimize visualization without affecting blood supply to the testes. Dissections are made and sperm retrieval is completed.
Microdissection is particularly useful to apply in men with smaller testes, as for example in men with Klinefelter’s syndrome. Microdissection is also easier to apply in cases of Sertoli-cell only pattern, as there is a greater difference between tubular diameter size. In cases of maturation arrest, microdissection assists in identifying the limited regions of sperm production.
Microdissection techniques make it feasible to retrieve sperm in men who would otherwise be unable to proceed with IVF/ICSI. Retrieval rates are improved, less testicular tissue is extracted and fertility is optimized for the infertile male. Careful coordination with the female partner’s reproductive endocrinologist is essential.
Microdissection TESE improves sperm retrieval outcomes, and allows retrieval of sperm in men whom sperm retrieval was unsuccessful with standard TESE approaches. Dr. Schlegel, a fertility expert,reports that sperm retrieval success increased from 45% to 63% after introduction of the microdissection technique.
Microdissection TESE is performed “fresh” at the time of egg retrieval, either the day before or day of. Cryopreservation of additional tissue is performed. Donor sperm backup is recommended to be used if no sperm are found on microdissection TESE.
PESA: Percutaneous Epididymal Sperm Aspiration
PESA is a procedure performed for men who are having sperm retrieved for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) who also have obstructive azoospermia from either a prior vasectomy, congenital abnormality such as CBAVD (congenital bilateral absence of the vas deferens, cystic fibrosis) or infection. It is done with local anesthesia in the operating room with sedation or under local anesthesia alone in the office. It can be performed in advance of an IVF cycle and cryopreserved, or coordinated with their female partner’s egg retrieval.
MESA: Microepididymal Sperm Aspiration
MESA is a procedure performed for men who have vasal or epididymal obstruction (s/p vasectomy, congenital bilateral absence of the vas deferens, cystic fibrosis), obstructive azoospermia. It is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval. MESA is performed in the operating room with general anesthesia under the operating microscope. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. With the use of PESA which is minimally invasive, MESA is not performed as frequently, but it does provide the most extensive retrieval for obstructive azoospermia.