Treatment - Testicular Biopsy & Microscopic Epididymal Sperm Aspiration (MESA)
There are some situations in which a sperm analysis reveals that there are no sperm at all in the ejaculate. An obvious example is where a man has had a previous vasectomy. There are other conditions which cause this problem. They include infection, which has blocked the tubes leading from the testis to the base of the penis, congenital absence of the tubes, chromosome or genetic problems, and other conditions in which there is limited or no sperm production at all by the testis.
After appropriate investigation of the male partner, which may include examination, hormone blood testing and genetic testing, the doctor may suggest that the sperm be collected directly from the testis by a small surgical procedure. Often, sperm are aspirated from the system of fine collecting tubules that carry the sperm from the testis to the base of the penis. For example, where a man has previously had a vasectomy (who does not want a vasectomy reversal) sperm can be found in the epididymis, in a procedure known as a Microscopic Epididymal Sperm Aspiration (MESA). The doctor will look for spem at a few sites along the length of the epidiymis, until viable sperm are found. One of the IVF Scientists will be in the theatre with the surgeon.
In other situations, the surgeon may take a biopsy or a small piece of the testis itself, where the sperm are actually produced. This serves both as a means of diagnosing the reason for the lack of sperm in the ejaculate, and collecting sperm where there are none found in the epidiymis. At the end of the procedure, we usually find enough sperm to perform several cycles of IVF, if required. The man is allowed to return home later the same day.
Sperm retrieval by such procedures must be injected into each egg in order for fertilisation to occur. Excess sperm can be frozen for future use.
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