For patients who cannot provide a semen sample or who do not have sperm in the semen sample, methods of searching for sperm in the tissue are used. Since the sperm obtained from here is injected into the egg using the ICSI method, even if there are very few sperm, this is usually sufficient.
There are several different techniques for surgical sperm retrieval. While not all are suitable for every patient, deciding the most appropriate method for the patient and the IVF doctor will help achieve the most successful result.
If sperm is not observed in the semen, there may be three main reasons for this:
- Problems with sperm production due to problems in the testicles
- Interruption of sperm production in the testicles due to hormone problems
- Blockage in the channels that carry sperm
Whatever the reason, in all three cases, a surgical sperm search can be attempted. Depending on the reason, the sperm cell can be found in the testicle where the sperm is produced or in the epididymis where the produced sperm is stored. The success rate in all these procedures varies depending on the reason why the sperm is not in the semen.
TESA procedure
TESA is the abbreviation for testicular sperm aspiration. In this procedure, the sperm channels in the testicle are reached with a special thin needle, and the fluid inside is withdrawn. This fluid is then examined in the embryology laboratory to search for sperm. The sperm found can either be used directly to fertilise the egg or frozen and used in a later IVF attempt. If sperm cannot be obtained, TESE or micro TESE procedures can be tried to search for sperm.
Although TESA surgery is not a very painful procedure, it is performed under light anaesthesia in the IVF centre of our hospital to prevent patients from feeling pain.
TESE / Micro TESE procedure
TESE is short for testicular sperm extraction. In this procedure, small biopsies are taken from various parts of the testicle, and these biopsy samples are examined in the embryology laboratory to search for sperm. The sperm found can either be used directly to fertilise the egg or frozen and used in a later IVF attempt.
In microTESE surgery, the scrotum sac containing the testicle is opened with an incision and the testicle is examined with special microscopes and biopsies are taken from areas where sperm may be detected. The biopsy samples are examined in the embryology laboratory to search for sperm. The sperm found can be used directly to fertilise the egg or frozen and used in a later IVF trial.
Since TESE and microTESE surgeries require the removal of a small piece of the testicle, they are performed under light anaesthesia in the IVF centre of our hospital.
The microTESE procedure is preferred today because it is a more successful method than TESE and is an operation that leaves less tissue damage. If sperm cannot be obtained with microTESE, various treatments can be given to support sperm production, and the microTESE procedure can be repeated later.
PESA
PESA is the abbreviation for percutaneous epididymal sperm aspiration. This procedure is used when there is a problem with the exit channels of sperm produced normally in the testicle. This method is a successful sperm retrieval method, especially in male patients who have had a vasectomy. The epididymal sac is entered with a special needle, and the fluid in the sac is withdrawn. This fluid is then examined in the embryology laboratory to look for sperm. The sperm found can be used directly to fertilise the egg or frozen and used in a later IVF trial. If sperm cannot be obtained with this method, MESA or TESA procedures can be tried.
Although PESA surgery is not a very painful procedure, it is performed under light anaesthesia in the IVF centre of our hospital to prevent patients from feeling pain.
MESA
MESA is the abbreviation for microsurgical epididymal sperm aspiration. In this procedure, the scrotum sac containing the testicles and epididymis is opened with an incision, the epididymis is examined with special microscopes and fluid is withdrawn with a special needle from areas where sperm may be detected. The fluid samples taken are examined in the embryology laboratory to search for sperm. The sperm found can either be used directly to fertilise the egg or frozen and used in a later IVF attempt. If sperm cannot be obtained with the MESA surgery, TESA or microTESE procedures can be tried.
MESA surgery is performed under light anaesthesia in the IVF centre of our hospital.
What should be considered after the surgical sperm retrieval procedure ?
The procedure performed by specialist physicians in our hospital is painless as it is performed under anaesthesia. Our patients can be discharged approximately one hour after the procedure and can return to their everyday lives quickly. However, to ensure the fastest recovery after the procedure, the following points should be taken into consideration:
- Avoid sexual stimulation and ejaculation for 10-15 days
- Avoid heavy lifting or strenuous sports activities for 10-15 days
- Avoid bathing or showering for the dressing period specified by the doctor (3 to 5 days)
- Use of tight panties or jockstraps that support the testicles for the period specified by the doctor
- Regular use of recommended painkillers if there is pain
- Apply cold compresses to the tissue for the specified periods after the procedure
