The test tube baby treatment can help aspiring parents to overcome their infertility issues. While the treatment itself is quite effective in cases where the female partner suffers from a range of infertility causes like endometriosis or PCOS, there are instances where the male partner’s sperm is hard to obtain.
The reasons for this difficulty are numerous, which is why the sperm in such cases needs to be retrieved surgically. The procedure adds to the actual IVF charges but in the absence of sperm during ejaculation, it is the only viable option left.
What is TESE/PESA?
Any top IVF centre in India typically uses these techniques to retrieve sperm surgically. Surgical retrieval of sperm is the only option when sperm is not present in the male’s ejaculate. This can be a problem for couples who want to get pregnant. Although surgical, these are minimally invasive techniques and can usually be performed as outpatient procedures with minimal sedation and anaesthesia. Thanks to the techniques, sperm can be retrieved directly from the epididymis or testes and used for procedures like IVF and ICSI.
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Why Are These Techniques Needed?
Surgical interventions for sperm retrieval are needed in cases where,
- A previously vasectomized male’s vasectomy reversal fails.
- The vas deferens, which carries sperm from the testicle to the urethra, is absent in the male.
- The male suffers from obstructive azoospermia, a condition where sperm is not present in the ejaculate which doesn’t let pregnancy happen.
- The male suffers from non-obstructive azoospermia, a condition where production of sperm is too low to achieve pregnancy successfully.
Once the sperm is obtained, they can either be used for an IVF procedure or surrogacy. That said, only the finest IVF or the top rated surrogacy center in India offers surgical sperm retrieval and IVF/surrogacy under the same roof.
What Are The Various Sperm Retrieval Techniques?
PESA (Percutaneous Epididymal Sperm Aspiration):
PESA does not need any surgical incision. Instead, the procedure involves inserting a small needle through the scrotal skin and directly into the head of the epididymis. Once inside, the needle aspirates (draws) the fluid. An embryologist then retrieves sperm cells from this fluid and gets them ready for use in IVF-ICSI.
MESA (Microsurgical Epididymal Sperm Aspiration) :
MESA is a procedure that is recommended to males suffering from problems like epididymal or vasal obstruction. The method involves dissecting the epididymis and creating an incision in one of the tubules. This incision causes fluid to spill from the epididymal tubule and into the epididymal bed. It is then aspirated using a fine needle. The entire technique is performed using an operating microscope. Since the epididymis features a large number of veins, MESA carries the risk of contamination by blood cells which can affect a sperm’s fertilizing capability.
TESA & TESE :
TESA (Testicular Sperm Aspiration) involves the insertion of a needle into the testicle and aspirating the sperm/tissue for use in IVF-ICSI. On the other hand, TESE (Testicular Sperm Extraction) involves creating an incision in the testicle and retrieving sperm from the tubules therein. Both procedures can be performed with light levels of local anaesthesia or sedation and can help males who do not ejaculate sperm along with their semen. However, the TESE procedure has been largely replaced by microTESE as the best sperm retrieval method for men suffering from azoospermia.
Microdissection TESE – Also known as microTESE, the procedure is ideal for males who suffer from poor sperm production and who are azoospermic. It is performed under general anaesthesia using an operating microscope. MicroTESE has a significantly high sperm retrieval rate among men suffering from azoospermia. It’s also a much safer procedure as a minimal amount of testicular tissue is removed. Among different sperm retrieval techniques, the microTESE success rate is the highest.
Dr Pranay Shah
Director and Chief Fertility Consultant
Dr. Divyesh Bhalodia
Counseller and Communicator
Dr. Dhruti Maheshwari
Do These Techniques Cause Pain?
Surgical sperm retrieval techniques are normally performed under general or local anaesthesia with pain relief and deep sedation. If the procedures are done in a facility fit to be called the best IVF center in India, they can also be done in a short period of time and usually allow the patient to return home after a few hours once they start feeling comfortable again.
What are the Benefits of these Techniques?
Male factor infertility is responsible for approximately 50% of infertility cases among couples. Furthermore, a major reason for male infertility is the poor quality of semen. It includes low sperm motility, low sperm count and low sperm with normal morphology. Moreover, roughly 30% of low quality sperm show DNA damage and a high level of DNA fragmentation. Both these issues do not manifest in the course of normal semen analysis. This is an important factor which can lead to an unsuccessful IVF or ICSI cycle. Sperm retrieval techniques can thus be used for azoospermia treatment and as a workaround for issues like failed vasectomy reversal. This invariably boosts the success rates of an IVF/ICSI treatment and allows a couple to realize their dreams of parenthood.
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