Azoospermia means that there are no sperm in the ejaculate. In order for pregnancy to occur with azospermia, a testicular biopsy is used to obtain spermatozoa. After a biopsy, the resulting sperm is used for the following purposes:
Namely, based on further goals (testicular puncture for sperm sampling or diagnosis), the andrologist decides on the depth of the intervention, determines which biopsy will be used.
A testicular biopsy is recommended for the following conditions:
Modern reproductive medicine uses the following biopsy methods:
TESA (lat. testicular sperma spiration, TESA) is the most popular and patient-friendly method. The procedure is performed under intravenous anesthesia, takes a quarter of an hour, and after an hour the patient is able to return home on his own. The course of laboratory research involves 5-6 procedures. If spermatozoa could not be found, they are used for other methods. The advantages of the method include the cost, the absence of an open biopsy and microsurgery. Compared to other methods, the disadvantages include the relatively low efficiency of TESA.
TESE (lat. testicular sperm extraction) is an effective analytical procedure. It also takes a quarter of an hour, and rehabilitation, like TESA, takes an hour. The main advantage of the method is the impressive sampling of testicular tissues, some of which are used in morphological studies, while the second part is sent for storage, subsequently used for egg fertilization. The procedure is performed under intravenous anesthesia and the results of histological studies are prepared for about a week.
"Properly performed TESE helps to prescribe an effective course of treatment for male infertility with non-obstructive azoospermia, as one of its common causes".
PESA (Latin percut aneous epididymal sperm aspiration) - this research method, involves piercing the epididymis. When it comes to obstructive azoospermia, this research is rated as 100% effective. The scrotal membranes do not break, and the results are obtained by aspirating a liquid mixture that mimics the environment of the fallopian tubes, through a needle inserted through the skin into the appendage. Success largely depends on the examination of the appendix and its adequacy. The procedure is performed under local anesthesia, sometimes general. Using the local variant, the seminal vesicle is anesthetized. The initial rehabilitation (pressure on the injection site, primary dressing) takes an hour, complete rehabilitation (bandages, cold, special underwear) takes a day.
MESA (Latin microsurgical epididymal sperm aspiration, in medicine micro-TESE) - it is a procedure to collect fluid from the spermatic cord, followed by the extraction of sperm. The methodology was developed in the United States in 2005. The purpose of the method is to withdraw 3-5 gr. tissue filled with sperm. The dimensions of the sample to be taken are in the range of 2-3 mm. The testicular tissue is preliminarily examined under a microscope, the best seminal tubules are selected and removed.
Micro-TESE has several advantages:
Unfortunately, spermatozoa obtained by such methods often have abnormal morphology, and their number is small. To improve the chances of pregnancy in male infertility, IVF uses IMSI. If the first IMSI was not effective, then the spermatozoa preserved by cryopreservation make it possible to repeat the IMSI, without the necessity for repeated surgical interventions in the testicle.
If none of the proposed ones helped to obtain the necessary healthy sperm, it is recommended to use donor material.
The consequences of such interventions for a man will be minimal if he adheres to all the doctor's recommendations before and after the procedure. TESE, TESA, PESA, micro-TESE is a chance for their own children for couples whose determining factor is male infertility.
You can learn more about the cost of these types of procedures from the coordinator of the DAHNO clinic.