services - Sperm Retrieval
In men without sperm in their ejaculate, they may have a problem with obstruction, or lack of production. MicroTESE is considered the gold standard therapy to surgically identify and retrieve sperm in men with severely compromised sperm production and no sperm in their semen.
What is Azoospermia?
This condition is a male fertility issue that is commonly referred to as having “no sperm count” in the ejaculate. There are two broad categories of azoospermia:
- Obstructive azoospermia means sperm is made but is then blocked somewhere from the testicle to the ejaculatory duct in the urethra.
- Non-obstructive azoospermia (NOA) means there is not enough sperm production to be seen in the semen. A testicle may produce very small quantities of sperm that need to be surgically extracted to use for IVF or there may be absolutely no production of sperm. NOA doesn’t mean there is no chance a man can produce sperm. There are many reasons, many of these reversible, why a man may have NOA.
Different types of Non-Obstructive Azoospermia?
In non-obstructive azoospermia, two general underlying issues may be present: 1. A problem with hormone production is not signaling the testis to produce sperm; 2. A defect exists in spermatogenesis, or the process of sperm production. Both scenarios may require microTESE, but medical therapy and optimization will differ between these two groups and thus a detailed workup is necessary.
Work-up for Non-Obstructive Azoospermia?
A hormone and genetic work-up provides the specialist important information to determine if medical therapy will be of benefit to optimize the chances of sperm production, as well as to help counsel the patient on the probability of finding sperm in particular scenarios.
What is a microTESE?
MicroTESE is a microsurgical procedure used to find rare sperm in men with poor sperm production, otherwise termed non-obstructive azoospermia. It was first described by Dr. Flannigan’s mentor, Dr. Peter Schlegel in 1997. The seminiferous tubules are the site of sperm production and comprise the vast majority of testicular contents. Using a powerful surgical microscope, these tubules are systematically evaluated to identify healthier areas that are more likely to contain sperm. These areas are selectively removed and further processed to try to identify sperm that may be present in focal locations in the testicle. By only performing focal biopsies significantly less tissue is excised compared to conventional TESE biopsies. This translates to a reduced loss of testosterone production and damage compared conventional techniques.
Who gets a microTESE?
The absence of sperm is detected through a semen analysis, where no sperm is identified under the microscope, even after using a specialized machine, i.e. centrifuge, to concentrate the cells of the specimen prior to microscopic searching. This can then be classified broadly as 1. a production problem (creation of sperm in the testis); 2. an obstruction (sperm production is intact, but one of the anatomic structures carrying sperm is blocked); 3. Impaired ejaculation (semen and sperm don’t flow during ejaculation or flow in a ‘retrograde’ direction into the bladder). When sperm production is the problem, it is termed non-obstructive azoospermia.
What is the success rate of microTESE?
Particular clinical scenarios increase or decrease the chances of finding sperm during a microTESE, and thus it is important to discuss your particular scenario with your surgeon for prognostic information. However, among all-comers, sperm is successfully identified in approximately 55% of cases.
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Flannigan Fertility offers male fertility treatments from our world-class facilities in Vancouver, Canada.