A. Non Surgical Sperm Aspiration
a.Testicular Sperm Aspiration -TESA
In TESA performed in our clinic under local Anesthesia , one can easily and quickly obtain adequate numbers of sperm for ICSI in many men who have no sperm in their semen because of vasectomy or other causes of blocked ducts; in men who cannot ejaculate including men with spinal cord injury.
Men who lack living sperm in their ejaculate frequently have at least some sperm in the testicles, where sperm are made. Testicular sperm can fertilize if they are injected directly into the eggs through a process called ICSI (Intracytoplasmic Sperm Injection.)
TESA is performed under sedation, and is painless and rapid. A tiny needle is used to extract sperm directly from the testis. While the ejaculate normally contains 100 million to 300 million sperm, aspiration of as few as 100-200 sperm by NSA have been enough to achieve pregnancy when it is combined with ICSI.
Prior to the development of TESA, men with no sperm in their ejaculate had to undergo surgery to remove sperm either from their testes or from tubes connected to the testis. Non-surgical sperm aspiration is rapid, does not require hospitalization, is pain-free when done under sedation, and recovery is virtually immediate.
The technique will be immensely helpful to men who have had vasectomies and later decide that they want to have children. It is possible to reverse a vasectomy by having bypass surgery, but the operation is frequently not successful, especially for men with long-standing vasectomies. Additionally, sperm quality after vasectomy reversal is often reduced and ICSI is required even if sperm appear in the ejaculate.
For many men, non-surgical sperm aspiration eliminates the need for vas reversal surgery. Men who cannot ejaculate due to spinal cord injuries or neurological conditions like multiple sclerosis can also become fathers through the new technique. There is also a large group of infertile men who simply have no sperm or only dead sperm in their semen although their ducts and ejaculatory process are normal, and who can have testicular sperm obtained through NSA.
b. Percutaneous Epididymal Sperm Aspiration PESA
In this the sperms are directly aspirated with the aid of a small needle mounted on a syringe. The skin is not cut open .The aspirate is given to the laboratory, where the sperms are identified and ICSI is performed. PESA will also help infertile men who lack sperm in their semen because the route out of the testes has been blocked by prior infection or congenital lack of development (Congenital Bilateral Absence of Vas Deferens CBAVD), as well as men who have had their prostates removed and can no longer ejaculate but make sperm.
NSA must be done with ICSI because testicular sperm cannot enter eggs by themselves. The female partner receives a series of medications to increase the number of eggs created by the ovary as in a conventional IVF cycle. When the eggs grow to adequate size, they are extracted non- surgically at the Institute under sedation, and NSA is scheduled the same day. After egg retrieval and sperm aspiration, our embryologists will inject each egg with a single sperm. Two days after the procedures, definite information regarding fertilization of the eggs and the number of embryos will be available. Embryos will be transferred back to the uterus two or three days following fertilization; additional embryos may be cryopreserved (frozen), as requested.
It should be noted that for some men a single NSA procedure may yield enough sperm to permit sperm freezing for several subsequent ICSI attempts.
B. Testicular Sperm Extraction(TESE)
There is a particular group of males who have no sperms in their semen. Also standard testicular biopsy procedure, done in the past , have shown no spermatogenic activity. In recent times, many such males, have undergone the procedure of TESE. The biopsy specimen thus obtained, has been meticulously searched for sperms, over 2 to 6 hours, sperms obtained, ICSI performed and pregnancies achieved. As many as 10 -30% men with established testicular failure, have fathered kids with this technique.