Men are considered infertile if they produce no sperm cells (azoospermia), too few sperm cells (oligospermia), or if their sperm cells are abnormal or die before they can reach the egg. Chronic problems with ejaculation (sperm released at orgasm) also contribute to male infertility. In rare cases, infertility in men is caused by an inherited condition, such as Cystic Fibrosis or chromosomal abnormality.
Male factor infertility and female factor infertility contribute equally to a couple’s infertility. Treatment of male infertility depends on the cause how long you’ve been infertile, your age and personal preferences. Often, an exact cause of infertility can’t be identified. Even if an exact cause isn’t clear, your doctor may be able to recommend treatments that work.
PESA (percutaneous epidydimal sperm aspiration) and TESA (testicular sperm aspiration) are procedures that are performed to obtain sperm in certain cases of male infertility. PESA or TESA can be performed on men that have zero sperm counts due to either a sperm production problem or a blockage in their reproductive tract, such as the result of a vasectomy, congenital absence of vas deferens, or infection.
Once a diagnosis of azoospermia (zero sperm count) has been made, we work closely with a urologist with specialized training in male infertility who will retrieve the sperm. The urologist will first perform an exam and further testing which may involve blood work and/or a testicular biopsy. The result of these studies determines which procedure is more appropriate and more likely to yield sperm.
While PESA is usually performed in our Center the morning of the egg retrieval, TESA may be done the day prior to the egg retrieval to allow in vitro maturation of immature sperm. With PESA, a small needle is placed into the epidydimis, which is a reservoir of sperm that sits atop each testicle, using local anesthesia. During TESA, sperm is obtained by means of a biopsy of the testicle. The sperm obtained from these procedures is then injected directly into the eggs (ICSI).
PESA / TESA procedure should be used when there is no sperm in ejaculate (so called ‘azoospermia) confirmed in two independent semen assessments.
The procedure can be done under local anaesthesia or short intravenous sedation. For aspiration of sperm from the epidydymis (so called PESA) as well as for aspiration of sperm directly from the testicles (so called TESA) we use special, fine needles which make the procedure less invasive.
PESA/TESA takes about 15-20 minutes and sperm aspirated during that procedure are usually cyropreserved and are to be used for ICSI (IVF with injection of a single, selected sperm) on the day of the egg collection.
Testicular failure affects approximately 1% of the male population and 10% of men who seek fertility evaluation. Azoospermic men with testicular failure (non-obstructive azoospermia) have either Sertoli cell-only pattern, maturation arrest, or hypospermatogenesis on testis biopsy. Until recently, it was assumed that men with non-obstructive azoospermia were untreatable. The only options offered to these couples to have children were the use of donor spermatozoa or adoption. Several clinically relevant findings have changed our approach to this condition. First, we have observed that direct evaluation of testis biopsy specimens often demonstrates sperm in men with non-obstructive azoospermia, despite severe defects in spermatogenesis.
Retrieval of sperm from the testis or epididymis is associated with good pregnancy rates using in vitro fertilization. Micromanipulation of gametes during assisted reproduction could improve these pregnancy rates. Subsequently, we have observed that optimized in vitro micromanipulation techniques can further enhance fertilization and pregnancy rates using epididymal or testicular sperm. Sperm can be retrieved from the testes of men with obstructive azoospermia and used with the assisted reproductive procedure of intracytoplasmic sperm injection (ICSI) during in vitro fertilization (IVF) with a high chance of achieving pregnancies and deliveries of normal children. These findings have led investigators from Belgium and elsewhere to perform testicular sperm extraction (TESE) with ICSI for men with non-obstructive azoospermia. Low pregnancy rates of 20 to 21% per attempt have been reported.
The introduction of Intracytoplasmic Sperm Injection (ICSI) has revolutionized the management of male infertility. Here, a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems.
Following egg retrieval, sperm is injected into the egg. About 70 percent of eggs get fertilized. Fertilization is confirmed 18-24 hours after retrieval. ICSI is a highly successful technique used to help couples who have previously failed to achieve conception with standard IVF.
Why is ICSI Done?
If a man does not have any sperm in his ejaculate, but he is producing sperm, they may be retrieved through testicular sperm extraction, or TESE. Sperm retrieved through TESE require the use of ICSI. ICSI is also used in cases of retrograde ejaculation, if the sperm are retrieved from the man’s urine.
Microscopic Epididymal Sperm Aspiration (MESA) is a technique for the retrieval of sperm from the epididymis of men in whom transport of sperm from the testicle to the ejaculate is not possible because the drainage (ductal) system is absent or is not subject to reconstruction. This problem most commonly occurs in men with vasal agenesis, a condition in which the vas deferens or drainage system of the testicle fails to develop prior to birth. The majority of these men have mutations of the Cystic Fibrosis (CF) gene; therefore, their female partners require CF testing.
Semen cryopreservation (the freezing of sperm) is a way to store sperm for future use. Men who must undergo medical procedures that may leave them sterile may wish to consider semen cryopreservation e.g. cancer chemotherapy, radiotherapy. Semen cryopreservation is also used before IVF to acquire multiple semen samples in men.
Donor sperm are recommended when sperm is not produced from the semen, often due to genetic causes, chemotherapy, radiation therapy or vasectomy. Donor sperm are also an option for single women, couples with genetic disorders, and couples in which the woman is Rh-sensitized and the man is Rh-positive. In most cases, anonymous donors provide semen to sperm banks. All donor sperm and embryos derived from donated oocytes are frozen and quarantined as the donor undergoes screening for infectious diseases such as HIV.
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I'm sure that many people will find it to be a big decision as I did to come to a different country not knowing anyone and worrying about the language barrier, and being so far from home. But yet we came here with full support from the team of Safemedtrip who made sure that we met the experts in the field of infertility who guided us well throughout.
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- Ms.Sherber, USA IVF, ICSI, IUI, Male & Female Infertility TreatmentsRefer a Patient
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