Azoospermia is a condition in which there is absence of sperm in the ejaculate. This can further be classified as non obstructive azoospermia (due to problem in sperm production) and obstructive azoospermia (due to obstruction in the male reproductive outflow tract). Causes of reproductive tract obstruction can either be acquired ( due to infection, trauma, iatrogenic injury during bladder neck, abdominopelvic or inguinal-scrotal surgery) or it can be inherited such as congenital bilateral absence of the vas deferens (CBAVD). CBAVD is mostly associated with cystic fibrosis which has autosomal recessive inheritance.
Two techniques - Epididymal sperm retrieval & micromanipulation have revolutionized the treatment of male infertility in the past decade. It is now possible for men having congenital bilateral absence of the vas defences (CBAVD) or reproductive tract obstruction to achieve pregnancies with use of advanced techniques such as PESA ,TESA or TESE. In all these techniques, sperms are extracted from the testis and then a single sperm is injected (ICSI) into a single egg using a machine called micromanipulator.
PESA(per cutaneous epididymal sperm aspiration )
This procedure involves needle being placed directly into the epididymis and does not require a surgical incision. A small needle is passed directly through the scrotal skin and fluid is aspirated. The embryologist retrieves the sperms from the fluid and prepares them for ICSI. Our unit is well known in this technique. We have done hundreds of PESA since 1996.
TESA (Testicular Eperm Aspiration)
TESA or testicular sperm aspiration is done by inserting a needle in the testis and aspirating fluid and tissue with a negative pressure. The aspirated tissue is then processed in the embryology laboratory by the embryologist and the sperms extracted from the fluid are used for ICSI.
TESE(Testicular Sperm Extraction)
This is a surgical sperm retrieval procedure which is used for fertility treatment for men with both obstructive and non-obstructive azoospermia. TESE is useful in those who have no sperm in their ejaculate either due to a blockage in the route between the site of sperm production (testes) and ejaculation or because there is a partial or complete failure in sperm production in the testes. TESE is a minor theatre procedure carried out on an outpatient basis under general anaesthesia. Sperms that are retrieved from the testes can be used to achieve fertilisation of eggs in the laboratory. TESE is often combined with ICSI as the number of sperm retrieved are less. If adequate number of sperm are identified on this occasion, it is sometimes possible to freeze the testicular extract and to thaw and use this sample for subsequent treatment. If there are adequate numbers of sperm present, the sample can be frozen for use in future treatment cycles.
Micro dissection TESE also called micro TESE or m Tese
Microdissection Testicular sperm extraction is a surgical sperm retrieval procedure used in fertility treatment for men who have no sperm in their ejaculate, due to failure of testicular function (non obstructive azoospermia) It is a surgical biopsy of the testis where an advanced operating micro dissecting microscope is used to pinpoint the testicular tissue to be removed. This causes less damage to the structure inside the testicle, thus having fewer after effects such as blood supply problems caused by tiny blood vessels being injured. It also appears to increase the sperm retrieval number.
Advantage of Micro TESE over TESE includes:
1. Higher sperm retrieval rates
2. Reduced acute post-operative complications
3. Fewer chronic changes to testicular function
4. Fewer complication seen on ultrasound
In our unit, our aim is to first retrieve sperms by TESA , If that fails (ie no sperm obtained) , we then do mapping and if still sperms are not retrieved, we resort to micro tesa . Alternately , if the patients has failed to get sperms on TESA outside , we would go straight for doing micro tese .
Our unit is one of the leading units in the world, performing Micro TESE. World famous andrologist & Urosurgeon Dr Rupin Shah, does micro TESE in our unit . Many males who have failed TESA in other centres have come to our units, where we were able to get sperm through micro TESE and subsequently these men managed to have babies with their own sperms.