When conception is the goal, most couples willingly agree to a full range of procedures that result in the birth of a child. But that doesn’t mean those procedures can’t be made as comfortable and cost effective as possible. For men who have no sperm present in the ejaculate, several types of minimally invasive surgical procedures are available to extract sperm from the testicles.
Microsurgical Testicular Sperm Extraction
Microsurgical testicular sperm extraction (MicroTESE) is a procedure to extract sperm from the testicle. In men with non-obstructive azoospermia (NOA), surgically extracting sperm with this procedure can make in-vitro fertilization (IVF) possible. MicroTESE involves a microdissection of the testicle under an operating microscope. The testicle is opened up and physicians look for the tubes or areas where sperm live to extract tubes most likely to have sperm.
Microdissection success rates have improved in recent years, giving more patients options. However, because this procedure can result in very low numbers of sperm, IVF is the only compatible method of fertility.
Testicular Sperm Aspiration (TESA)
The Froedtert & the Medical College of Wisconsin Reproductive Medicine Center is the only program of its kind in the Milwaukee area offering testicular sperm aspiration, or TESA, a minimally invasive procedure for men with zero sperm count (azoospermia). It has been a treatment option for men who visit the Reproductive Medicine Center for eight years.
TESA is performed by a urologist using a local anesthetic, a small needle and a special syringe to extract sperm directly from the testicles to be used for diagnosis and/or sperm freezing. Unlike the traditional open testicular biopsy, TESA saves time, and ultimately, cost for the patient. The procedure takes approximately 20 to 30 minutes. Recovery is shorter and significantly less painful. While open testicular surgery may require a recovery period of nearly a week, TESA is often done on a Friday afternoon, allowing men to rest and heal over the weekend and return to work Monday.
It is well-tolerated, and the outcome — often the most important consideration — is just as effective.
Treatment for Men With No Sperm Count
Typical candidates for TESA are men who have had a vasectomy they choose not to reverse, men with blockages, or those who cannot produce sperm in the ejaculate, but are producing sperm in the testicles. In addition to vasectomy, causes for lack of sperm may include prior testicular trauma, a congenital condition, or previous infection.
Doctors can determine whether TESA is an option after obtaining specific medical information about the patient. TESA extracts as much sperm and tissue as an open testicular biopsy and results can be delivered immediately. Laboratory staff view results right in the procedure room of the clinic, and determine whether further analysis is necessary.
If, as in rare cases, a testicular cancer is diagnosed, the urologist can perform a TESA procedure to extract the patient’s sperm from the non-cancerous testis and freeze it prior to cancer treatment if the patient cannot ejaculate on his own.
Also known as fine needle aspiration (FNA) biopsy of the testicle, testicular mapping is a non-surgical method of determining the extent of azoospermia and the presence of sperm.
Percutaneous Epididymal Sperm Aspiration (PESA)
Percutaneous epididymal sperm aspiration uses a tiny needle passed into the epididymis to retrieve sperm. This minimally invasive approach is most often used with men with obstructive azoospermia, such as after a vasectomy.
In an abundance of caution, care and concern for our patients, staff and community, we are delaying fertility treatment starts until we have a greater sense of the degree of COVID-19 transmission in our region. We will closely follow ASRM and CDC recommendations as they become available.