In approximately 7% of men undergoing microsurgical epididymal sperm aspiration (MESA), spermatozoa retrieval is not possible. In these patients in whom the epididymal sperm reservoir is inaccessible, recent work has shown that whole, motile sperm can be obtained from the testicle itself. Critical for the success of testicular sperm extraction (TESE) is determination that the testis is making mature sperm.

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This can be confirmed by diagnostic testicular biopsy, which is sent for touch preparation (cytology), image analysis, and standard histology. If mature sperm with complete tails are present on these examinations, TESE is feasible. Because of the low number of sperm obtained with TESE, these sperm need to be combined with the wife’s eggs using intracytoplasmic sperm injection (ICSI). The absence of mature sperm on these histologic examinations indicates that successful retrieval is probably unlikely.

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Patients who require TESE can be divided into two categories : –

(1) The first set of patients are those men whose epididymis is not accessible because of previous epididymal procedures or congenital efferent ductal obstruction in the testis. This group with an obstructed testicle represents the first set of patients in whom successful TESE was combined with ICSI, and in 1994 a 42% clinical pregnancy rate was reported. More recent reports have demonstrated that in these obstructed patients, testicular retrieval seldom yields unusable sperm.

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(2) Patients with testicular biopsies demonstrating Sertoli-cell-only, maturation arrest, or severe hypospermatogenesis represent another group of patients in whom testicular sperm retrieval has been used. These patients, who until recently were felt to be untreatable, can now often be treated effectively with in vitro fertilization (IVF) and ICSI if areas of normal sperm production can be demonstrated in a testicular biopsy.

MESA, TESE and Micro TESE Treatment in india

The procedures are either performed through the skin (percutaneous) or through a small opening in the skin about 1/2 inch in size. Applying microsurgical techniques in a process known as Microscopic Epididymal Sperm Aspiration (MESA), sperm can be gathered from the epididymis, a sperm rich tube at the back of the testis. Testicular Sperm Extraction (TESE) involves removing small samples of testis tissue for processing and eventual extraction of sperm. Microscopic TESE (MicroTESE) is a very exacting search for sperm under high magnification in cases of extremely low sperm production.

Sperm Retrieval and IVF Treatment in india

Up until 1992, couples faced with these hurdles would have been given no hope of making babies involving both of their genes. With the advent of a particular type of In Vitro Fertilization (IVF) called Intra Cytoplasmic Sperm Injection (ICSI), a single sperm is injected into each ripe female egg. This allows even a few retrieved sperm to be adequate for fertilization and has led to countless “miracle babies”. The minute quantities of sperm obtained at retrieval are not enough to be useful to Intra Uterine Insemination (IUI) or any procedure other than ICSI. MESA and TESE procedures are the most popular because the goal is retrieval of sufficient sperm for freezing and use in future IVF cycles using ICSI.

MESA and TESE are often performed in advance of the IVF cycle and frozen to reduce stress on the couple since the sperm is “safe in the bank” and can be used at any time. This approach allows each partner to be supportive to the needs of the other at time of their procedure. In general, frozen sperm is just fine for IVF/ICSI but each program has its own requirements to optimize pregnancy results. Dr. Bastuba and his staff work closely together with the IVF lab during the couple’s infertility treatment. Sometimes sperm quality or quantity requires use of “fresh” sperm. The chosen sperm retrieval method would then be timed to coincide with the female egg retrieval and IVF/ICSI cycle. The percutaneous methods are always done fresh since sperm quantity and quality are not sufficient to allow for freezing.

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