Surgical Removal of Sperm
In some cases of assisted reproduction it is necessary to extract sperm surgically in order to fertilise eggs during IVF.
In some cases of assisted reproduction it is necessary to extract sperm surgically in order to fertilise eggs during IVF.
There are three methods of sperm extraction available at CRGH.
- Micro-Epididymal Sperm Aspiration (MESA)
- Percuateous Epididymal Sperm Aspiration (PESA)
- Testicular Sperm Extraction (TESE)
Micro-Epididymal Sperm Aspiration (MESA)
Micro-epididymal sperm aspiration (MESA) is indicated for patients with congenital absence of the vas deferens (the vas is the channel that carries sperm from the epididymis to the penis). The procedure is also indicated for patients with failed reversal of vasectomy and for patients with epididymal obstruction from previous infection.
The operation is carried out under general anaesthetic as a day case and requires a couple of hours' operating time. A small incision is made in the scrotum (the skin around the testicle). The epididymis is then exposed and microsurgical aspiration of fluid micro-droplets is then undertaken through a minute incision in the epididymal tubules.
The fluid is analysed for the presence of sperm. The number of tubules excised is very much dependent on the amount of sperm retrieved and their motility.
You may experience some discomfort and swelling for a few days after the operation. The symptoms can be alleviated by taking simple pain-killers such as paracetamol.
You may experience some discomfort and swelling for a few days after the operation. The symptoms can be alleviated by taking simple pain-killers such as paracetamol.
When it is not possible for the sperm to travel beyond the testicles to reach the penis for ejaculation, then sperm can be retrieved by two different methods known as PESA or TESE.
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA is a minimally invasive technique in which a fine needle is passed into the epididymis under local anaesthesia to extract fluid. This fluid is then analysed to ascertain whether it contains sperm.
Should the fluid not contain sperm it maybe necessary to proceed to a TESE procedure.
Testicular Sperm Extraction (TESE)
This procedure is usually performed under a general anaesthetic and involves either a small incision being made, or the passing of a fine needle into the testes. A small sample of testicular tissue is then removed to be and analysed by the embryologists for sperm.
Sperm obtained from the epididymis or the testicles by any of the above three procedures will usually have nonprogressive motility (poor movement) and in order to improve the chances of fertilisation the sperm are usually microinjected into each egg (by the process known as intracytoplasmic sperm injection or ICSI).
