Sperm are special cells produced by the testicles in men that contain the genetic materials necessary to fertilize an egg. However, most cases of male infertility occur as a result of negative factors occurring in the sperm. In order for infertility treatments to be carried out effectively, a certain amount of sperm must be obtained from the man. Since sperm cells are found in semen, a semen sample is generally taken from men by masturbation. The presence of low number and quality of sperm in the semen fluid, no motile sperm or no sperm cells (azoospermia) will affect the chances of success of the methods to be applied with assisted reproductive techniques.
Methods of obtaining sperm from the testicle are very important in terms of improving the quality of the embryo formed by in vitro fertilization methods and increasing the chance of pregnancy.
What are the methods of obtaining sperm from testicles?
If the reason for a couple’s infertility is the presence of sperm numerical, motility or structural disorders in the semen fluid called ejaculation in the man during sexual intercourse, or the absence of any sperm (azoospermia), surgical collection is required. Sperms can be collected from the testicle or from the epididymis region where sperm are collected on the testicles. In preparation for assisted reproductive techniques, a semen sample from the man must be taken and examined, and the man must be examined in detail by a urologist.
The purpose of methods of obtaining sperm from testicles; Obtaining sperm cells that do not come out from testicular tissue, the organ where they are produced; or, in cases where the sperm quality released by some men is not suitable, it is to obtain sperm of better quality and in sufficient number for the microinjection (ICSI) method.
The type of treatment is applied according to the cause of the problem and there are 5 different options:
Percutaneous epididymal sperm aspiration (PESA)
Microsurgical epididymal sperm aspiration (MESA)
Testicular sperm aspiration (TESA)
Testicular sperm extraction (TESE)
Microscopic testicular sperm extraction (Micro TESE)
In what cases can sperm be obtained from the testicles?
For men who do not have sperm in their semen and want to have a baby, sperm can be obtained from the testicles by surgical methods.
In the problem known as obstructive azoospermia, sperm production is present, but there are no sperm cells in the semen due to any blockage in the sperm ducts. In this case, PESA, MESA, TESA or TESE procedures can be applied.
Factors that cause obstructive azoospermia are:
Having a vasectomy (connection of sperm ducts) operation,
Preventing sperm release due to injury,
Having a sexually transmitted infection such as chlamydia-gonorrhea,
Congenital absence of vas deferens (sperm ducts),
Prostate and bladder neck operations,
Blockage of the seminal duct after catheterization or urethra surgery,
Experiencing ejaculation problems such as retrograde ejaculation.
If there is no sperm in the semen (azoospermia) due to sperm production problem, non-obstructive azoospermia may occur and the most suitable method for this is Micro TESE operation.
Factors that cause non-obstructive azoospermia are as follows:
Cancer treatments such as chemotherapy or radiotherapy,
Genetic diseases that affect fertility,
Removal of a testicle
Surgeries due to undescended testicles.
Among the methods of obtaining sperm from testicular tissue in men with sperm production disorders, open surgical methods are more successful in finding more sperm than the closed, that is, needle aspiration method. Among open surgical methods, micro TESE operation is considered to have the highest chance of success in finding sperm.
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How to choose the right method?
The man’s fertility evaluation should be done together with his partner. If azoospermia or severe oligozoospermia with very few sperm cells is detected as a result of the evaluation, a complete medical history, physical examination, and laboratory tests are requested. In some cases, a testicular biopsy may also be required for the final stage of diagnosis. With this procedure, a small piece of tissue is removed from the testicle and it can be seen that azoospermia is caused by a blockage or a problem with sperm production. As a result of all these examinations, a urologist who specializes in reproductive medicine and surgery will choose the sperm retrieval method that is most suitable for the person.
Each technique has advantages and disadvantages. Choosing the right method will be an important step in a successful pregnancy.
What is testicular sperm aspiration (TESA)?
TESA is a procedure in which sperm required for in vitro fertilization treatment or microinjection is retrieved. It is usually done with local anesthesia and coordinated with the egg retrieval of the female partner. A needle is passed into the testicle and sperm is aspirated. TESA is preferred in men diagnosed with obstructive azoospermia or undergoing vasectomy. In some cases, an open testicular biopsy is required because TESA cannot provide sufficient tissue or sperm.
What is Percutaneous Epididymal Sperm Aspiration (PESA)?
PESA is one of the preferred sperm collection methods in cases of obstructive azoospermia caused by vasectomy or infection. It is performed under local anesthesia and is carried out simultaneously with the egg retrieval of the female partner. With this technique, since the needle is applied through the skin without being seen, there are problems such as obtaining a low number of sperm, bleeding or not being able to obtain sperm, so we use the MESA procedure, which is a procedure performed visually under a microscope.
What is testicular sperm extraction (TESE)?
TESE involves making a small incision in the testicle and taking a tissue sample to examine the presence of sperm in it. It is done as a scheduled procedure or may be done simultaneously with the female partner’s egg retrieval. TESE can be performed under local or general anesthesia.
What is micro epididymal sperm aspiration (MESA)?
MESA is a procedure performed for men with congenital bilateral absence of the vas deferens or epididymal obstruction. It is performed in the operating room under general anesthesia or local anesthesia using an operating microscope. A small incision is made in the skin of the scrotum and the epididymis is accessed. MESA allows the collection of larger numbers of mature sperm compared to aspiration techniques. The fluid coming out of the epididymis is examined for sperm. If motile sperm are seen, they are removed for immediate use or frozen for future use.
What is microscopic testicular sperm extraction (Micro TESE)?
Micro TESE is a procedure performed for men with sperm production problems and azoospermia. It is performed under general anesthesia and a special microscope is used to view sperm cells during the operation. MicroTESE has significantly improved the rates of both obtaining a higher number of sperm and finding quality sperm from the testicular tissue in azoospermic men. Additionally, since less testicular tissue is removed, it has been considered one of the most reliable procedures among the methods of obtaining sperm from the testicle.
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