Sperm aspiration/retrieval techniques are used with IVF-ICSI and can be performed in many ways (MESA, TESA, TESE, microbes) depending on the situation for each patient/couple – ranging from men who have had a vasectomy to men who do not have sperm in the ejaculated semen, known as azoospermia.
The reason men have no sperm in the semen can be genetic, hormonal or unknown. In up to 10% of cases, the genetic reason is a missing piece of the male Y chromosome, known as the AZF region. Some men may also have pieces of one chromosome on another (translocation) or too many X chromosomes. These can be checked by performing blood work. Azoospermia is not the end of the road for having biological children.
Even though a man may not have sperm in the semen, there may still be pockets of sperm in the testicles that are not getting out and can be retrieved in up to 60% of cases. This does require a special type of sperm retrieval called microTESE, which is an extensive biopsy using an operating microscope. This does have to be performed in the operating room. The number of sperm can only be used with IVF-ICSI. Genetic counseling of a couple is sometimes needed especially if a known genetic problem is found.
Another group of patients may develop infertility – patients who receive chemotherapy or radiation for cancer. In these cases, men should try to freeze sperm prior to treatment for later use if their counts are too low or zero. Hope is not lost in those who did not freeze and may require microTESE or use of assisted reproductive techniques.
Spinal cord injury in a young man is another reason for fertility problems – mainly because of ejaculatory issues. In this situation, special methods are required to retrieve sperm for couples to have children.
Sometimes men have retrograde ejaculation – sperm going into the bladder, e.g., diabetics, spinal cord injuries, neurologic issues, urologic/prostate surgery and medications. Retrieval of the sperm from the bladder can be performed to use with assisted reproduction. Sometimes medications can reverse retrograde ejaculation.
We have a comprehensive male infertility center that includes an andrology laboratory capable of semen analysis, cryopreservation and other sophisticated sperm testing.