Men who are in need of in vitro fertilization (IVF) fall into two general categories: Obstructed and Non-Obstructed patients. Obstruction is caused either by prior vasectomy or by conditions in which the outflow tubing of the testicles has been damaged or failed to form properly from birth.
Below is a list of common procedures done.
Testicular Sperm Extraction (TESE) and Micro Dissection TESE
In some cases, sperm is taken directly from the testicle for IVF. This occurs in men with very low sperm production who have no sperm in the ejaculation in which the cause is not from a blockage, called nonobstructive azoospermia. It also occurs in some men with epididymal scarring, previously failed vasectomy reversal and in some men with congenial blockages of the sperm ducts. TESE can be done with local anesthesia in an office or in a surgery center with many other anesthesia options.
Tissue that is extracted is immediately examined to determine the presence or absence of sperm. In so instances, multiple areas of the testis will need to be sampled in order to find adequate numbers of healthy sperm. In cases where only small “pockets” of sperm production may exist within the testis, a technique known as microdissection TESE would be performed. This procedure has been shown to allow for the detection of visible sperm in many previously untreatable men.
Microscopic Epididymal Sperm Aspiration (MESA)
In obstructed patients, sperm may be harvested surgically from the epididymis in the high numbers with high motility. This can be done in two ways. One way it can be done is through the skin, percutaneously or it can be done open surgically with the operating microscope. Usually, the open technique allows for a much greater harvest of sperm to be frozen but requires a minor surgery with a small scrotal incision. Recovery time, however, is very brief. The surgery takes about 30 minutes and is done as an outpatient. Once the sperm is cryopreserved, it can be used at any fertility center in the country.