Testicular Sperm Aspiration Or Extraction
Now that researchers have found that intra cytoplasmic sperm injection (ICSI) with sperm obtained straight from the testes really works, there is hope that just about any case of male infertility can be treated with great success. Since that time, men with insufficient or absent sperm production (azoospermy) have been able to father children, as long as live sperm from the inside of the testicular tissue could be extracted.
While this type of non-obstructive azoospermy is the most significant indication for testicular sperm aspiration (TESA) or testicular sperm extraction (TESE), there are other conditions in which these techniques may prove useful. However, for now, there is no way to predict whether there will be viable sperm in the testicular tissues prior to performing these procedures in the case where individuals have confirmed non-obstructive azoospermy. FSH levels, for instance, cannot be used as a predictive indicator. Everything can look just fine and even so, it may not be possible to obtain sperm through TESE or TESA procedures. For this reason, physicians will often suggest that a couple use donor sperm if no sperm are found during TESE or TESA.
There are two different methods by which one can remove sperm from the testicle. This can be done by sperm extraction from an open biopsy (TESE), or sperm aspiration from the testicle through the use of a fine needle (TESA). Both procedures can be done with the help of local anesthesia in the form of a sperm chord block, or with light sedation.
In open biopsy (TESE), an incision of a single centimeter is made in the skin of the scrotum and a small fragment of testicular tissue is removed. A very small fragment is all that is needed to provide sufficient sperm for an ICSI procedure. But in cases where non-obstructive azoospermy exists in tandem with arrested germ cell maturation for instance, it may be necessary to take 3 or more specimens of testicular tissue.
Testicular aspiration done with a fine needle, TESA, is a most simple procedure. The testicle is held with the thumb, index, and middle fingers. The other hand introduces the needle straight into the testicle. The needle is attached to a syringe. Penetration with the needle must be at a right angle to the scrotum skin so that negative pressure is created. This is repeated 4-6 times, each time a small distance away from the last site along the testicle.
The needle is removed and the material is sent to a laboratory for analysis. If the presence of sperm is deemed to be non-existent, the doctor is phoned and another aspiration is done. If this too, fails, the next step is sperm extraction direct from the testicle (TESE).