ICSI and Sperm Aspiration
There's Hope For Poor Sperm
Many couples find themselves in a position where they are unable to conceive after a year or more of trying. Infertility may be due to a number of factors affecting one or the other of the partners. Infertility is almost a 50-50 proposition, with both male and female partners experiencing conception difficulty. This has moved the assisted reproduction technology industry forward exponentially. Developments in in-vitro fertility (IVF) and intracytoplasmic sperm injection (ICSI) have significantly altered the biological requirements for reproduction.
Male Infertility Causes
As mentioned, there are various reasons for infertility on both sides of the equation. Male infertility is most commonly caused by:
· varicolcele, widening of the veins along the cord that hold up a man's testicles
· obstruction, plugged vans deferens
· idiopathic, that is no known cause
· cryptorchidism, the failure of one or both of the testes to descend into the scrotum
Options for Men With Sperm Issues
Men who find themselves infertile yet want to father a child have three basic options open to them in order to fulfill their desire:
1. Vasectomy reversal of the surgery (if they've had a vasectomy)
2. Sperm aspiration from the testicle or vans deferens and then use of ICSI to fertilize the egg and IVF and embryo transfer to conceive
3. Donor sperm insemination to the woman
Since most men who want to conceive with their partner want the child to be biologically theirs and they've had a vasectomy, then a reversal is the first suggestion by medical doctors. Should that not be possible or if there are other circumstances surrounding the infertility, then sperm aspiration and ICSI are the next methods of choice.
Methods of Extracting Sperm
There are three primary methods of sperm aspiration and extraction procedures and two that are less familiar, all of which have unwieldy names that have been distilled down to acronyms.
Microsurgical Epididymal Sperm Aspiration (MESA): An incision is made through the scrotal skin and using optical magnification, the epididymal tubules are cut and the sperm fluid is aspirated. Typically, a large number of motile sperm are retrieved and can be used immediately for ICSI injection into the egg. Or, it can be frozen for use later in subsequent cycles of IVF-ICSI procedures if necessary.
Percutaneous Epididymal Sperm Aspiration (PESA): A needle is used to insert through the scrotal skin and into the epididymis to aspirate the sperm. Since the epididymal tubule is very tiny and delicate, there is usually only a small amount of sperm that can be withdrawn, enough for one cycle of IVF-ICSI that will be performed on the same day the sperm is withdrawn. There are instances where the sperm may not be able to be withdrawn at all with this procedure.
Testicular Sperm Extraction: A small incision is made in the scrotal skin and the testicle is investigated. Small pieces of tissue are cut directly out of the testicle and the sperm is extracted from the tissue directly. When there is poor production of sperm, several incisions may be required in order to find enough sperm. The sperm must be used within 24 hours of retrieval and the tissue can be frozen for later use.
Testis Perc Biopsy: This method uses a larger gauge biopsy needle to perform the same procedure are TESA.
Testis Microdissection: When a man has a very low level of sperm production, then extensive searching may have to be performed in order to obtain sufficient sperm for conception. An incision is made in the scrotum and using an operating microscope, the inner contents of the testicle are dissected and searched through until an area that has normal sperm production is found. The area is cut out and an embryologist removes the sperm from the tissue. Typically, the number of sperm found is sufficient only for one cycle and must be used within 24 hours of egg retrieval from the woman.
All of these procedures carry similar risks: bleeding, infection, and permanent damage to the testicle that may require lifelong testosterone supplementation. However, complications are not common and most men go through the procedures without problem.
ART has opened the door to parenthood for countless couples. Our site is full of information to help you become better informed about infertility and what is available to help you conceive.