In Vtitro Fertilization
Dr. Nudell offers all state of the art testing and procedures for men with male factor infertility needing IVF. This usually involves a simple office evaluation followed by close work with the IVF physicians. Dr. Nudell has works with most of the major IVF centers in the area.
Men needing procedures to extract sperm 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. Having said that, every sperm extraction patient is different and requires the type of one on one discussion Dr. Nudell always gives his patients.
Below is a list of the most common procedures done.
Testicular sperm extraction (TESE) and Micro dissection TESE
In some cases, sperm are taken directly from the testicle for in vitro fertilization. This occurs in men with very low sperm production who have no sperm in the ejaculate in which the cause is not from a blockage (called nonobstructive azoospermia). It also occurs in some men with epididymal scarring, previous failed vasectomy reversal and in some men with congenital blockages of the sperm ducts. TESE can be done in either the office (local anesthesia) or in the surgery center (many anesthesia options). As a microsurgeon, Dr. Nudell performs the state of the art TESE which is called Micro-dissection TESE. This is done using an operating microscope to better target very small areas of the testis where pockets of sperm production exist.
Tissue that is extracted is immediately examined by Dr. Nudell and an embryologist to determine the presence or absence of sperm. In some instances, multiple areas of the testis will need to by sampled (all through the same skin incision) 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. Dr. Nudell has extensive experience in this given his microsurgical background. In these cases, this procedure has been shown to allow for the detection of viable sperm in many previously untreatable men.
Microscopic epididymal sperm aspiration (MESA)
In obstructed patients, sperm may be harvested surgically from the epididymis in high numbers with high motility. This can be done either percutaneously (through the skin with a needle) or open (surgically with the operating microscope). In general, 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 form either, however is very brief. Surgery takes about 30 minutes and is done as an out-patient. Once sperm is cryopreserved, it can be used at any fertility center around the
country.