Sperm Extraction Techniques for ICSI
For an artificial insemination with own sperm and for IVF l ICSI, the contribution of the man is to deliver a fresh sperm sample trough masturbation.
As part of the treatment for IVF or ICSI (fertilization of an egg via the injection of one sperm), it is possible that the man may require some form of intervention to be performed, to collect sperm for the procedure.
In some men, the ejaculated semen contains insufficient numbers of sperm, but, there may be sperm present in the testicles, which can be obtained by means of a small operative procedure.
Thanks to the nature of the ICSI technique, only a few sperm will be needed, nor do they require to be fully mature, because as of the moment they are produced in the testicles, they contain all of the genetic information from the man and can be directly used in the laboratory, to fertilize the egg.
The procedure to obtain the sperm from the man is normally performed on the same day as the womans' Pick up, so that we can have as fresh a sample as possible.
General principles for sperm extraction procedures:
- they can take place either under local or general anaesthetic;
- only MESA is carried out only under general anaesthetic;
- vibrostimulation is performed without any form of anaesthetic;
- electro-ejaculation takes place under general anaesthetic, or should the man be paralyzed, without anaesthesia;
- you may go home later on the same day, a night in the hospital is not necessary;
- the different options and types of procedure will be discussed with you beforehand and you will be involved in the decision as to which one will be performed, depending on the results of previous investigations;
- your procedure will usually take place on the same day as the pick up of your partner. This is because we prefer to use fresh material whenever possible;
- the procedure usually provides us with sufficient sperms to perform the fertilization process with your partners' eggs. Surplus sperms may be frozen and used at a later date in a subsequent treatment, in which case you will need to have signed a consent form before the intervention is performed. However your signing the consent form does not necessarily mean that freezing excess sperm will be possible in your case.
Which extraction procedure that is implemented in your case will depend on the nature of the problem (cf. Looking for the cause
in anejaculation we implement a method of vibro- and electrostimulation.
Anejaculation, means that you do produce sufficient sperm, but that you are unable to ejaculate, even though you are able to get an erection. The problem is commoner than you might think. There are a number of reasons:
- neurological damage through trauma to the spinal column (e.g. in men who are partially paralyzed);
- as a result of surgery for testicular cancer;
- as a result of multiple sclerosis;
- as a result of diabetes with nerve involvement;
- unexplained anejaculation, whether they be physical or psychological.
in azospermia other techniques are used:
Azospermia means that there are no (or only dead) sperm present in the ejaculate. Which of the four available techniques is used, depends upon the nature of the cause. Even in normal healthy sperm production, not all the sperms which are produced make it into the ejaculate. There is always a small percentage which are lost along the way. But if there are no sperms at all in the ejaculate,
it can be due to a blockage somewhere along the sperms' journey. This is known as obstructive azospermia. Sperm production is normal, but they cannot get out. In this type of problem, all four methods of sperm retrieval can be considered;
it can be due to the fact that there is insufficient production of sperm cells in the testicles, or they do not ripen properly. This is known as non obstructive azspermia
is the only considerable option;
it can be due to a hormonal imbalance (this is unusual), in which case the problem must be rectified with medication. See hormone treatment
MESA & PESA: sperm from the epididymis.
Sperm extraction via MESA.
Sperm extraction via PESA.
Fine Needle Aspiration (FNA)
As previously discussed above, obstructive azospermia is the condition whereby the normal healthy sperm cannot get out due to a blockage somewhere along the way. for example in the vas deferens (or due to the absence thereof). During a MESA or PESA operation, the lab checks whether sufficient amounts of sperm have been extracted. The procedure may possibly carried out on both sides.
MESA [day case procedure]
(microsurgical epididymal sperm aspiration)
Sperm cells are surgically extracted from the epididymis. Under general anaesthetic, a small incision is made in the scrotum and a special microscope is used to select a suitable area, from which the sperm cells are then aspirated.
PESA [day case procedure)
(percutaneous epididymal sperm extraction)
This procedure does not involve an incision. Under local anaesthetic, the epididymis is punctured through the skin and aspirated. This is a very simple technique, but does not always result in sufficient sperm retrieval.
FNA & TESE: sperm from the testicle
In certain cases, sperm has to be searched for in the testicle itself, before they go to the epididymis to ripen. These two procedures usually result in less sperm retrieval than the other techniques.
FNA [day case procedure]
(fine needle aspiration)
With a fine needle, the testicle is punctured and aspirated, in the hope of obtaining sperm cells. It is a simple technique, which does not always result in sufficient sperm being found. It can be used in cases of non obstructive azospermia, but results in far too few sperm to be able to freeze and store surplus numbers.
TESE [day case procedure] (testicular sperm extraction)
If FNA does not result in sufficient sperm, or if you wish to have sperm banked and stored, then TESE is the procedure of choice. One small biopsy, taken under local anaesthetic is usually enough to provide the sperm required to perform ICSI and to freeze for later.
TESE: several pieces of testicular tissue
They are rinsed and taken to the lab for
The tubules are pulled apart to free up the
sperm producing cells.
Under the microscope, between the sperm
producing cells, actual sperms can be seen,
recognizable by their tales.
In the case of non obstructive azospermia, TESE is the only option and is best performed under general anaesthetic if multiple biopsies are to be made on both testicles.
Even in cases where only small numbers of sperm are produced, TESE can usually provide enough sperm for ICSI in about half of the cases and even provide enough for freezing and storage.
The biopsies are surgically removed and then transported to the lab, where they are prepared and examined for the presence of sperm.
After the operation, the surgeon will inform you as to whether sufficient sperm was found for the ICSI procedure and/or for the purposes of storage. In the case of the latter, you will have to have previously signed a consent form.
Vibro- and electrostimulation
In men for whom it is physically impossible to ejaculate, whether it be due to psychological or physical reasons, ejaculation can be achieved by use of vibro or electrical stimulation. However these two methods are not covered by the mutuality.
Before the procedure, there will be a number of investigations performed: your hormonal profile and infection status will be determined via blood and urine tests. If there are any infections, these will be treated before the procedure can be performed.
Most sperm samples obtained after a period of inactivity are of poor quality. The very best sperms will be selected from the sample for use in the fertilization of your partners' eggs.
Vibro stimulation to the penis
Electrical impulses are administered via the
Because ICSI is best performed with fresh sperm, you will undergo the procedure on the same day on which your partners' Pick up is scheduled. If you want any excess sperm frozen and stored for later use, then you will need to complete a consent form
prior to the intervention.
Vibro stimulation [day case procedure]
A vibrating apparatus is held to the penis, with which a possible reflex leading to ejaculation may occur. A reflex is something which you cannot control, like the heave reflex if you stick your finger down your throat.
Electro stimulation [day case procedure)
During this procedure, a special probe is inserted into the rectum. Via electrical impulses, certain nerves are stimulated, causing an erection and subsequently, ejaculation.
In order to have this procedure, you will have to sign a specific consent form
containing information regarding the intervention. Your doctor will give you this information as well beforehand.