Extracting Sperm For IVF
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MESA sperm aspiration

Sperm Aspiration

Contents

What Is Sperm Aspiration?
When Is It Performed?
Can The Sperm Be Used For Artificial Insemination?
What Is The Procedure For Sperm Aspiration?
Sperm Aspiration After Vasectomy
How Much Does Sperm Aspiration Cost?
What Are The Pregnancy Success Rates?



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Assisted Reproductive Technology
Terminology: Also called non-surgical sperm aspiration (NSA).

What Is Sperm Aspiration?

Sperm aspiration refers to a group of procedures used to extract usable sperm from a man's reproductive area. The sperm is extracted by injection. It is then injected using ICSI procedure (intracytoplasmic sperm injection) into his partner's egg in a laboratory. The resulting embryo is implanted in the woman with the hope it will develop into a successful pregnancy. This procedure is reserved for men suffering from severe male infertility, where they are literally 'firing blanks'.

When Is It Performed?

Sperm aspiration allows men with severe fertility issues to father children. If no sperm can be found in the semen on ejaculation (technically known as azoospermia), sperm can be extracted directly from the testes. The testes are another name for balls or testicles. There are two main reasons why there may be no sperm in the semen. One is due to a blockage in the reproductive tract (obstructive azoospermia). The other is because sperm are trapped inside the epididymis (a little organ that sits on top of the testicle), even though sperm production in the testes might be normal.

Can The Sperm Be Used For Artificial Insemination?

No. The collected sperm cannot be used for artificial insemination (also known as intrauterine insemination or IUI). The reason being not enough sperm is retrieved by aspiration for artificial insemination to work. At least 5 to 8 million motile sperm (sperm that can swim) with normal morphology (shape) are required for artificial insemination. The sperm are injected into the womb with the hope that one will find the egg and fertilize it. Far fewer sperm are required for ICSI to be successful because the sperm is injected directly into the egg.

What Is The Procedure For Sperm Aspiration?

There are 4 different methods of sperm aspiration. Each procedure has its pros and cons and not all are options are suitable for every patient. A fertility doctor will need to carry out fertility tests to gain a thorough knowledge of the cause of infertility, before recommending a method. See also, causes of infertility in men.

The 4 methods are:-

MESA (Microsurgical epididymal sperm aspiration)
This procedure is only useful in cases of obstructive azoospermia because men with nonobstructive azoospermia rarely have sperm in the epididymis. A small incision is made in the scrotum (the flesh surrounding the testicles). A lighted microscope is inserted into the tubes of the epididymis. Fluid is extracted and examined in an IVF lab for sperm. If sperm is present it will be frozen until needed. If only dead sperm are found in the fluid, or no sperm are present, the procedure is repeated until enough sperm can be gathered. MESA can be performed in a doctor’s office and recovery only takes 1 day. Sedation is administered during the procedure. While MESA is the most effective sperm aspiration technique, it is relatively unavailable. This is because it is only offered in fertility clinics that specialize in male infertility.

PESA (Percutaneous epididymal sperm aspiration)
PESA is cheaper than MESA, but less effective. A needle is inserted through the scrotum into the epididymis in the hope that a pocket of sperm can be found. PESA is a blind procedure, no guided microscope is used. If a blood vessel is accidentally poked it will continue to bleed resulting in a hematoma (bruised, bloody looking area of skin). Frequently a second procedure has to be performed to save an IVF cycle because PESA has failed to yield any workable sperm.

TESE (Testicular sperm extraction)
TESE is an open procedure performed under direct observation which means complications are kept to a minimum. A small piece of testicular tissue is removed through a 2cm skin incision in the scrotum. Sperm is extracted in a lab from the tubes in the testicular tissue. Testicular sperm does not freeze or thaw as well as epididymis sperm, but it may be the only option for men with nonobstructive azoospermia.

TESA (Testicular sperm aspiration)
Less expensive than TESE, this is a blind procedure done using a needle to extract sperm from the testicle. The danger with this procedure is that an artery may be accidentally severed cutting off blood supply to the testicle. The testicle can shrink and die.

Sperm Aspiration After Vasectomy

Vasectomy is a semi-permanent form of male contraception. The reproductive tract is cut and tied or sealed so that sperm cannot enter ejaculation fluid (semen). For a long time it was considered a permanent form of male contraception, but advances in microsurgery have led to the development of a vasectomy reversal procedure. This operation lasts 3 to 6 hours and costs about $15,000. Sperm aspiration is an alternative to vasectomy reversal (not only is it cheaper, but it is far less painful). See also sperm banks for preserving fertility before vasectomy.

How Much Does Sperm Aspiration Cost?

Sperm aspiration costs about $2,500. Sperm banking (freezing and storing sperm) which is normally done with the procedure is another $400. Additionally, the ICSI procedure, needed to inject the sperm into an egg, is a further $1,900. Sperm aspiration does not need to be repeated for different IVF cycles if enough sperm is banked.

What Are The Pregnancy Success Rates?

Using Testicular Sperm
If the sperm is injected directly into the partner’s egg (oocytes) via ICSI, doctors are achieving fertilization rates of 60 percent using fresh testicular sperm and 55 percent with thawed testicular sperm. This translates into a pregnancy rate of 23 percent. Normal pregnancies seem to occur from testicular aspirated sperm. For the best results, it is advised to use stored sperm within 6 months of being extracted.

Using Epididymal Sperm
The most successful combination appears to be MESA followed by ICSI which has fertilization and pregnancy rates of between 45 and 52 percent.

  Related Articles on ART Procedures

For more information, see the following:

Pre-implantation genetic diagnosis: Testing for birth defects.
Embryo donation: Avoid alot of the hassle and get it donated!
Sperm donation procedure explained and sperm donor criteria.
Donor cytoplasm: IVF treatment, why you need to travel to have it.
Egg freezing: When the biological clock is ticking.

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