Surgical collection of sperm MESA, TESE
The diagnosis of azoospermia does not mean that there is no chance for reproduction.
Absence of sperm in sperm can have 2 major causes:
A. Obstructive – Obstruction or absence of ducts through which sperm are removed from the testicle
B. Non-obstructive – Defect of sperm production or maturation in the testicles
How do the two situations differ?
- Obstructive azoospermia: hormonal tests, urological examination and ultrasound usually show normal aspects, the only problem being in the parameters of the spermogram
- Non-obstructive azoospermia is usually associated with hormonal changes (increased FSH), changes in testicular volume / structure, sometimes genetic changes.
- There are also borderline forms, in which differentiation is difficult before intervention
How is surgical sperm harvesting performed?
It is a minimally invasive technique that involves either just puncturing and aspirating the epididymal canal through which sperm are evacuated, or biopsy the testicle and extract small testicular fragments.
It is usually performed with sedation / intravenous anesthesia.
The evaluation is performed in real time, the sample being sent to the laboratory during the intervention.
- If enough sperm are found after aspiration of the canal, the intervention is stopped.
- If no sperm are found. the urologist continues with the biopsy of the testicle.
Recommendations after intervention:
- You can eat 3-4 hours after surgery.
- Hold an intermittent bag of ice locally for 30-40 minutes on the first day
- Keep the dressing for 24 hours
- Do not drive a vehicle on the day of surgery if anesthesia has been administered.
- Resume the usual activities and the next day’s service
- Avoid sexual intercourse for the next 7 days
- A control after 14-21 days is recommended
Why is a complete diagnosis important before the intervention?
In obstructive azoospermia, the chances of finding sperm by testicular puncture / biopsy are very high, as is the probability of being able to freeze the obtained sample.
In non-obstructive azoospermia, the chances of finding sperm are very small. If found, they may be too few for freezing, but sufficient for an immediate reproductive technique.
Harvest time and techniques:
- Simultaneously with the IVF procedure – the sperm are used for fertilization
- Prior to the procedure – for diagnostic purposes or with the freezing of the sample obtained
- ESDP (Puncture – percutaneous epididymal aspiration)
- MESA (Puncture – microsurgical epididymal aspiration)
- THESIS (Testicular Biopsy)
- TESA (Testicular Aspiration)
What investigations are needed before surgical sperm collection?
- Spermogram and sperm culture
- Urological consultation
- Hormone profile: FSH, LH, Testosterone, Prolactin
- Usual tests: Blood group, Rh, Blood count, Blood glucose, Creatinine, Transaminases, PTT, aPTT
- Serological testing: HIV 1 and 2, Hepatitis B (Ag HBs and Ac HBc), Hepatitis C (Ac HCV), Lues (VDRL)
- Genetic testing – if the specialist suspects a possible genetic cause
- The risk of not finding viable sperm in the samples collected
- Possible immediate effects of the procedure: edema, discomfort or pain at the site of intervention, dizziness, nausea, allergic reactions to medication
- Alteration of reflexes. It is not allowed to drive after anesthesia.
- Risk of bleeding, infection, urinary retention
Chances of success
- In obstructive azoospermia the chance of finding enough sperm is very high, in most cases for both reproduction and freezing.
- In non-obstructive azoospermia the chances are lower, but there are results in these situations as well
- IVF / ICSI procedures with surgically harvested sperm have become common and have very close chances of success with IVF / ICSI performed for other reasons.