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Sperm Aspiration for ICSI

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Sperm Aspiration for ICSI

Men with no sperm at all in their ejaculate can now have their own child, because sperm can be retrieved from their testicle or epididymis and injected into their wives' eggs. The highest pregnancy rates with this approach and the least pain and discomfort to the male require that these sperm retrieval procedures be performed microsurgically, and not with either crude needlesticks or gross surgical techniques.

Even when there is no sperm whatsoever in the man's ejaculate (azoospermia), there is now a very good chance for pregnancy using our sperm retrieval and ICSI procedures. The techniques of sperm retrieval and ICSI were originally developed by us in Brussels, Belgium, and in St. Louis, Missouri.

Sperm Aspiration for ICSI imageThere are two types of azoospermia, obstructive and non-obstructive. Obstructive azoospermia can be caused by vasectomy, congenital absence of vas, poorly performed hernia type surgery, or epididymal scarring from prior infections. We have been able to reverse vasectomy for many years with over 90% success using microsurgery. However, when the obstruction is irreparable, the man's sterility, until recently, had been considered hopeless.

In cases of obstructive azoospermia, sperm aspiration with ICSI will give the same chance for getting pregnant as any couple with a normal sperm count undergoing IVF. We can micro-inject a single retrieved sperm directly into the substance of the egg and get normal fertilization. Virtually all (with some rare exceptions) of the couples in whom epididymal sperm are present have transfers of good embryos. 46% per each treatment cycle get pregnant and have a baby. Those who don't carry a baby still have a 46% chance if they try a second time. Virtually all couples have enough sperm to be frozen and stored. This frozen sperm can then be used at a later time in conjunction with another IVF/ICSI procedure for the wife. Thus, the husband does not need to undergo any more sperm aspiration procedures after the first one. The babies from ICSI are healthy and genetically normal.

Even when little or no sperm is found in the epididymal tubules, or when there is no epididymis, we can get good fertilization by using testicular sperm. The success rate is similar to that with epididymal sperm. The only drawback to using testicular sperm is that it does not freeze as well. However, these procedures can be done under local anesthesia, in a few minutes, with very little post-operative pain. One way or another, for cases of obstructive azoospermia, we can now always get sperm that are adequate for fertilization.

Another alternative you may have recently heard about is "fine needle aspiration". Fine needle aspiration is generally offered by doctors or clinics that do not have access to an operating room or delicate microsurgery. The only option these programs can offer you is to put a needle into the testicle in an attempt to retrieve sperm. The approach of microsurgical vasectomy reversal is the most cost-effective first choice option for fulfilling your desire to have children. However, either needle aspiration or microsurgical sperm retrieval plus ICSI is a good second choice for cases where a competent microsurgical vasectomy reversal has failed, or where the man is loathe to undergo surgery.

The other type of azoospermia (no sperm in the ejaculate) is non-obstructive, and this is caused by "apparent" absence of sperm production in a deficient testicle. A severe male fertility problem such as this, caused by extremely low, or apparently no, sperm production, with no sperm whatsoever reaching the ejaculate, now also has a very good chance for success using testicular sperm retrieval and ICSI. Our discovery is that despite what appears to be no sperm production, we can usually still find a few sperm in the husband's testicles, and use these few sperm to fertilize the wife's oocytes (eggs) via ICSI. The pregnancy rate in such cases is no different than in men with normal sperm counts. The reason this can be done is that in over 60% of men with azoospermia, and "no sperm production," there is a tiny focus of sperm production, making so few sperm that none can reach the ejaculate. But testicular sperm retrieval can help us microsurgically find these few sperm.

See also:

Comparing Microscopic Vasectomy Reversal vs. Sperm Retrieval and ICSI — Dr. Silber's conclusions

Microscopic (TESE) testicular sperm extraction for azoospermic men — By Dr. Silber

Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia — By Dr. Silber

MESA and TESE procedures performed under local anesthesia. (11:54 min.)
Sperm aspiration. (0:16 min.)

If you have any questions, you may call us at  (314) 576-1400.