ART (assisted reproductive technology) has many applications in the form of fertility treatments like IVF (in vitro fertilization) or IUI (intrauterine insemination). For either of these treatments, the fertility technician needs a few samples of healthy sperm cells. Among many men, the required sperm isn't available, i.e. sperm in the ejaculatory fluid is present in very scant quantities or totally absent (or only immature sperm are available). In such cases, surgical sperm aspiration is done.
Surgical Sperm Aspiration Basics
Surgical aspiration refers to the removal of fluid that is accumulated within a body organ or cavity using a fine needle. Surgical sperm aspiration refers to a method of artificially extracting the sperm from the epididymis or testis. Epididymis is a coiled, tube-like structure that contains the sperm. Within the epididymis, the sperms undergo a short phase of maturation that renders it motility and the potency to travel within the female reproductive tract and seep through the outer walls of the egg cells. Sperms aspirated from the epididymis need minimal preparation when used for fertilizing the female egg. Conversely, immature sperms extracted from testis need a greater degree of preparation and present a lower, success rate of fertilization.
Various microsurgical techniques used for aspiration of sperm have been listed below:
Also called Testicular Fine Needle Aspiration, this refers to the method of using a fine needle for extracting the sperm tissue under local anesthesia. It is commonly used in men who are suffering from azoospermia, a near absence of sperm in the ejaculatory fluid. This method is recommended for men where sperm cannot be located in the epididymis. Thus, the sperm is aspirated from the testis. Here, the testicular tissue is sucked-out and used for further preparation. The sample is prepped and a culture media is created in the laboratory. Then, sperms present within the seminiferous tubules are extracted and later treated for rendering them a minimal degree of motility.
Known as Percutaneous Epididymal Sperm Aspiration, this procedure is preferred since it raises the chances of aspirating fully-mature sperm. PESA is concentrated along the upper parts of epididymis that has a higher concentration of mature sperm. This is among the least expensive of the surgical sperm aspiration methods and also the most undemanding option. However, PESA cannot guarantee that a sizeable number of sperm will be obtained during the aspiration. Further, it induces a small risk of a vascular injury in the form of chances of rupturing a blood vessel. PESA is recommended to men who are apprehensive about incisions being made as a part of MESA.
Also called Microsurgical Epididymal Sperm Aspiration, this technique is more complex that TESA. Here, the sperm is aspirated from the blocked parts of the epididymis. The procedure involves a small incision that is made under general anesthesia. This method is recommended despite its complex nature since it allows aspiration of a larger number of mature, potent sperms. However, the need to make incisions in the scrotum can make many men apprehensive about MESA. The incision is later closed with sutures.
Though an outpatient procedure like TESA and PESA, this method often needs a few hours of recuperation at the physician’s clinic and might induce some pain around the incision site.