These procedures are offered to couples in cases where the male has no sperm present in the ejaculate. They are used in conjunction with an ICSI procedure. (For more information please see the ICSI section).
In some semen samples there may be no sperm present in the ejaculate. There can be a variety of reasons for an absence of sperm known as Azoospermia.
There may be a blockage of the tubules that carry the sperm from the testicles to the penis.
The passages themselves may not have developed so sperm cannot be transported. This is known as absence of the vas deferens. If the latter is diagnosed then genetic counselling may be offered as there can be a high risk of males with this diagnosis who are identified as carriers of the cystic fibrosis gene.
In some cases sperm may be produced but in low numbers, and therefore not seen in the semen sample.
The male may have had a vasectomy performed which means that the passages that carry the sperm have been severed.
PESA- Percutaneous Epididymal Sperm Aspiration
This procedure may be performed under GA or local anaesthetic with sedation. A fine needle is passed into the epididymis to extract fluid. This is then checked in the laboratory by the embryologist for sperm.
TESE- Testicular Sperm Extraction
This procedure may be performed under GA or local anaesthetic with sedation. A small sample of testicular tissue is extracted from the testes. This can be achieved by either a fine needle being inserted into the testes or a small incision being made.
Sperm that is extracted by the above procedures will then be used in conjunction with an ICSI cycle. ICSI involves a selected single sperm injected directly into a mature egg. The eggs will then be placed in an incubator and checked the following day for fertilisation. An Embryo Transfer is normally scheduled 2-3 days following egg collection.
Effects of ICSI
ICSI is still a relatively new procedure therefore the research on the effects that it may have on children born is still limited. It is possible that male children born may inherit the same type of infertility that the male partner presented if the sperm production was affected by a chromosome abnormality. Genetic counselling may be offered in such cases.
Which Option is Best for Us? ??
Having so many options is great because "one size does not fit all." A comprehensive male fertility evaluation and a careful discussion with you and your partner will determine which option is the safest and the most efficient way to locate and retrieve sperm for you. Each option has its advantages and disadvantages:
* Requires microsurgical expertise with fellowship-training preferable.
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