Microsurgical Sperm Retrieval

Many men we see don’t have sperm in their ejaculate.  This is called azoospermia. Approximately half of the time we find a blockage that prevents sperm from being transported from the testis where they are produced to the tip of the penis where they exit. In these cases this is termed Obstructive Azoospermia (OA). In the other patients we find markedly impaired sperm production in the testis. This is called Non-Obstructive Azoospermia (NOA) because the etiology is due to poor sperm production and not blockage.

With Obstructive causes the blockage is often due to infection or surgery (vasectomy) and can be repaired.  However, in some cases it is due to absence of the tubes that carry the sperm called the vas deferens or the smaller tubules right outside the testis called the epididymis.  In either of these cases of OA sperm can be retrieved from the testis by either a percutaneous  (through the scrotal skin) or open (testis biopsy) or even from the epididymal tubules (microsurgical epididymal sperm retrieval) or vas deferens. However, the sperm retrieved through any of these procedures must be used in in vitro fertilization (IVF) with use of intracytoplasmic sperm injection (ICSI) since the number of sperm retrieved and motility (movement) of the sperm retrieved is much less than that needed for intrauterine insemination (IUI).

However, with Non-Obstructive Azoospermia few sperm are usually present in the testis and a special surgical procedure calld microdissection Testicular Sperm Extraction (micro TESE) is performed. Unlike the standard testis biopsy which is taken from one portion of the testis usually in under an hour, the micro TESE often takes several hours of surgical time to remove only the tubules containing sperm (aka seminiferous tubules). In addition, this procedure requires an experienced Urologic microsurgeon and a team of experienced Andrologists (specialists in the laboratory techniques required to identify and extract sperm from the retrieved testicular tissue) to achieve the best possible success rates.

Tubules containing sperm appear full, are golden yellow in color and are often located near or between blood vessels.

micro TESE was first performed  at the time of oocyte retrieval. This was called a ‘fresh’ sperm retrieval.  However, many recent studies (see references below), including our own work, have shown that cryopreserved testicular sperm work exceptionally well and also have significant advantages:

1. micro TESE performed prior to the day of IVF/ICSI allows the couple to know that there is sperm available for insemination and can make an informed decision as to the potential for success of the IVF/ICSI procedure.

2.  micro TESE performed prior to the day of IVF/ICSI allows the male partner to accompany and drive the female partner home after the procedure.

3.  micro TESE performed prior to the day of IVF/ICSI can often provide sufficient sperm for multiple IVF/ICSI procedures

We have developed special protocols and have trained several licensed Medical Technologists that maximizes the probability of obtaining optimum sperm quantity and quality to be used with IVF/ICSI. In addition, our experienced Andrologists and specially designed incubators that accompany us to the operating room assure a controlled temperature and fluid environment for retrieved sperm during transport to our cryopreservation facility.

Our State-Of-The-Art Laboratory Facility

We pride ourselves in being the only Urology practice that has over 20 years experience in  sperm banking and a Urologist with over 25 years in microsurgical procedures.  Dr. Gilbert has been performing micro TESE for over 15 years with many beautiful children resulting. We are the only licensed facility in the NY metropolitan area that has a New York State licensed facility for processing and cryopreservation of the retrieved testicular tissue, a Urological Microsurgeon experienced in these procedures as well as Andrologists licensed and certified to assist with the laboratory aspects of the procedure in the operating room and laboratory which makes this procedure seamless for our patients.

REFERENCES:

1. D Eedkm. Commentary on manuscript: “The impact of fresh versus cryopreserved testicular sperm on

intracytoplasmic sperm injection (ICSI) pregnancy outcomes in men with azoospermia due to spermatogenic

dysfunction: a meta-analysis”. Fertility and Sterility. 2013:1–1.

2. Tavukcuoglu S, Al-Azawi T, Al-Hasani S, Khaki AA, Khaki A, Tasdemir S. Using Fresh and Frozen Testicular Sperm

Samples in Couples Undergoing ICSI-MicroTESE Treatment. J Reprod Infertil. 2013;14(2):79–84.

3. Wu B, Wong D, Lu S, Dickstein S, Silva M, Gelety TJ. Optimal use of fresh and frozen-thawed testicular sperm for

intracytoplasmic sperm injection in azoospermic patients. J Assist Reprod Genet. 2005;22(11-12):389–394.

4. Verheyen G. Should diagnostic testicular sperm retrieval followed by cryopreservation for later ICSI be the

procedure of choice for all patients with non-obstructive azoospermia? Human Reproduction. 2004;19(12):2822–

2830.

5. Borini A, Sereni E, Bonu MA, Flamigni C. Freezing a few testicular spermatozoa retrieved by TESA. Molecular and

Cellular Endocrinology. 2000;169(1-2):27–32.

6. Prins GS, Doglina R, Studney P, Kaplan B, Ross L, Niederberger C. Quality Of Cryopreserved Testicular

Sperm In Patients With Obstructive And Nonobstructive Azoospermia. J Urol. 1999;161(5):1504–1508.

7. Ben-Yosef D, Yogev L, Hauser R, et al. Testicular sperm retrieval and cryopreservation prior to initiating ovarian

stimulation as the first line approach in patients with non-obstructive azoospermia. 1999.

8. Friedler S, Raziel A, Soffer Y, Strassburger D, Komarovsky D, Ron-El R. The outcome of intracytoplasmic injection of

fresh and cryopreserved epididymal spermatozoa from patients with obstructive azoospermia–a comparative study.

Human Reproduction. 1998;13(7):1872–1877.

9. Friedler S, Raziel A, Soffer Y, Strassburger D, Komarovsky D, Ron-El R. Intracytoplasmic injection of fresh and

cryopreserved testicular spermatozoa in patients with nonobstructive azoospermia—a comparative study. Fertility

and Sterility. 1997;68(5):892–897.

Please call Dr. Gilbert with any questions: 516-487-2700