Sperm Aspiration Techniques
Sperm aspiration refers to a group of procedures offered through Bubtree and Monash IVF. These techniques are used to obtain sperm from the male reproductive tract when sperm cannot be obtained by ejaculation. Sperm collected by these techniques is intended for use during in-vitro fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). Usually insufficient sperm is obtained to be used for intra-uterine insemination (IUI).
When should sperm aspiration be considered?
Men who have no sperm in their ejaculate (azoospermia) can have sperm retrieved from their testicle or epididymis as described above. Generally, this happens in two types of situations.
Obstructive azoospermia occurs when there is a blockage somewhere in the male reproductive tract. This can be caused by vasectomy, absence from birth of part of the reproductive tract (congenital absence of the vas), as a complication of hernia surgery or as a result of scarring following an infection. Under these circumstances, sperm continues to be produced in the testicle but it cannot find its way into the ejaculate as the pathway to join the ejaculate is blocked or absent.
Non-obstructive azoospermia is the result of severe impairment or absence of the sperm production tissue in the testes. Whilst there is no sperm in the ejaculate, sometimes enough sperm for treatment with IVF and ICSI can be obtained by one of the sperm aspiration techniques described below.
Male fertility and Genetic testing prior to sperm collection
Before proceeding with a sperm aspiration technique it is often important to exclude other medical conditions that may be a cause for absent sperm in the ejaculate (azoospermia). When a man has absent sperm in his first semen sample, sperm can be found in up to 15% of cases in a second or subsequent test, and so a repeat semen analysis is often indicated. Furthermore, some men who have azoospermia can be carriers of certain inherited/genetic conditions and so additional screening may be indicated such as genetic testing (chromosomal), screening for a Y chromosome microdeletion and for cystic fibrosis. Other causes of azoospermia that could be screened for include hormone deficiencies and problems with ejaculation where the ejaculate goes into the bladder (so called retrograde ejaculation). Furthermore, hormone testing can often differentiate between whether there is obstructive or non-obstructive azoospermia. Consequently, it is important to undergo an expert male fertility assessment before proceeding with treatment.
Sperm collection techniques
There are four main approaches to sperm aspiration, and selection of the most appropriate technique for you is best undertaken by an expert in the area. In Microepididymal Sperm Aspiration (MESA) and Percutaneous Epididymal Sperm Aspiration (PESA) sperm are aspirated directly from the epididymis (the tiny collecting tubules next to the testes) for use in the ICSI procedure. If successful, the small amount of fluid obtained contains sufficient sperm to be used for ICSI. Furthermore, sperm can sometimes be frozen for use at a later date in IVF and ICSI.
Testicular Sperm Extraction (TESE) and Testicular Sperm Aspiration (TESA) are where small samples of testicular tissue are obtained and a very small number of sperm are carefully identified under the microscope by dissected them out of the sample of tissue. Sperm obtained by this technique are used in ICSI.
Vibrostimulation and electroejeculation are sperm collection techniques that can be used for men who have had spinal cord injuries, or some men who have problems with ejaculation.
How and where will my procedure be performed?
At Bubtree and Monash IVF Brisbane these procedures are performed by a medical specialist in the male reproductive tract (a urologist) who is an expert and has extensive experience in working in this area. Most of these procedures can be performed under local anaesthetic in Monash IVF Brisbane. In a few cases it may be necessary to be admitted as a day patient to hospital and have a general anaesthetic.