To understand sperm retrieval techniques, a basic understanding of sperm transport is necessary.
Sperm is formed and developed in the testicles. After being made, they are transported to a network of tubules called the epididymis where they continue to mature and gain the ability to move more effectively. They are then transported to the vas deferens (the area that is cut during a vasectomy) and finally during ejaculation, the sperm are rapidly propelled to the prostate and ejected out the penis.
There are a variety of techniques that Dr. Avila uses to retrieve sperm for in-vitro fertilization. Each couple’s specific needs and the male partner’s evaluation will dictate which procedure is the best for them.
Percutaneous Aspiration of Sperm
Dr. Avila can perform a number of techniques in which he can retrieve sperm from the testicle and epididymis through the skin or percutaneously. These procedures are usually performed with a retrieval needle and are done as an outpatient procedure with sedation. Percutaneous techniques are most successful in patients that may have an obstruction of sperm.
Microscopic Epididymal Sperm Aspiration
Another form of retrieving sperm is called microscopic epididymal sperm aspiration or MESA. During the MESA, sperm is directly taken from isolated epididymal tubule under a surgical operating room microscope. After sufficient sperm are obtained, the epididymal tubule is closed with microscopic sutures. By avoiding the blind passage of a retrieval needle into the epididymis and testicle, the couple continue to have the option of undergoing a vasectomy reversal in the future. A MESA procedure can be performed in advance of in-vitro so the couple can be assured the male has adequate sperm production.
Testicular Sperm Extraction and Microscopic Testicular Dissection
Azoospermia is a condition where there is no sperm seen on the semen analysis. This can be caused by a variety of reasons. Despite the diagnosis leading to Azoospermia, Dr. Avila has had success in retrieving sperm with either a testicular sperm extraction (TESE) or microscopic dissection of the testicles (microTESE). The TESE is performed by making a small incision into the testicle and removing a piece of testicular tissue to be used for in-vitro fertilization.
The microscopic testicular dissection is performed when the TESE is unsuccessful in identifying sperm. The testicle is carefully opened and with an operating microscope, the testicle is meticulously scanned and sampled for islands of sperm production. These islands are then retrieved and used for IVF. All of the above techniques should only be performed by a well-trained urologist. Dr. Avila is one of a handful of fellowship-trained specialists in male fertility and microsurgery practicing in the Southwest.
