Microdissection testicular sperm extraction (mTESE)
Microdissection testicular sperm extraction (mTESE) is a surgical procedure used to extract sperm from inside a man’s testicles. It is used in men who have a diagnosis of non-obstructive azoospermia (NOA). NOA is when no sperm is present in the ejaculate due to a production problem inside the testicle. Even though not enough sperm is made to find any in the ejaculate, sometimes we are able to find small islands of preserved sperm production inside the testicle NOA is a common cause of male infertility.
A MicroTESE allows men who otherwise would not be able to have a natural pregnancy to have a biological child of their own. Success rates are on average 50% for retrieval of sperm, but the individual chance of success will depend on the reason behind the non-obstructive azoospermia. This is something you can discuss with your male infertility doctor. To optimize your chances of success, your testosterone levels will be optimized before surgery.
This surgery is done using an operating microscope, under general anesthesia, at the Victoria General Hospital or at the Dartmouth General Hospital. The goal is to find small islands of preserved sperm production (see picture from one of Dr Ory’s cases) inside the testicle, which is only detectable using the high magnification of an operating microscope. Any sperm that is found is frozen for later use in an IVF/ICSI cycle.
This surgery is performed by Dr Ory, who is fellowship trained in male infertility and microsurgery. Recovery time afterwards is approximately 2 weeks.
Vasectomy Reversal or Vasoepididymostomy
A Vasectomy reversal is an excellent option for men to regain their ability to have children after a vasectomy. Success rates for vasectomy reversal are between 90-95% for return of sperm to the ejaculate.
Vasectomy reversals are all done by our male fertility expert Dr Ory under general anesthesia at the Victoria General Hospital or the Dartmouth General Hospital. An operating microscope is used for each case, and a bedside microscope is used to confirm that sperm is present in the vas before completing the vasectomy reversal.
Recovery time afterwards is approximately 2 weeks, after which time you can start trying for a child as long as your pain has resolved. Your first semen analysis will be done 3 months after surgery to check for a successful reconnection.
Sometimes, men will not have sperm present in their vas at the time of vasectomy reversal and will need a vasoepididymostomy instead. Success rates for this procedure are approximately 50% for return of sperm to the ejaculate. The majority of men who have had a vasectomy within 10 years will be able to have a vasectomy reversal, but rarely, men who have had their vasectomies a long time ago will need this done instead. This is also something that Dr Ory can provide if necessary.
Couples will often wonder whether or not to pursue vasectomy reversal or surgical sperm retrieval and IVF/ICSI in trying to build their family after a vasectomy. For an in depth look at the pros and cons of each option, please see the attached article published by Dr Ory.
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA is a surgical procedure used to extract sperm from inside a man’s epididymis. This is done for men with obstructive azoospermia (OA). OA most commonly happens in men after a vasectomy, but can also occur after certain infections scar down the vas, or in men with cystic fibrosis. If men are not interested in a vasectomy reversal, they can have a PESA to extract sperm and use it in an IVF/ICSI cycle.
A PESA is done at AART under local anesthesia with sedation. Sperm found at the time is frozen for later use. Very rarely, a PESA will not be successful, and you will need to be booked in the operating room under a general anesthetic for a microsurgical epididymal sperm aspiration (MESA).
Testicular Sperm Aspiration (TESA)
A TESA is a surgical procedure used to extract sperm from inside a man’s testicle. This is usually done if the diagnosis of non-obstructive azoospermia or obstructive azoospermia is unclear. It is also frequently performed if a man with normal fertility is unable to provide an ejaculated sperm sample for any reason for use in an IVF/ICSI cycle. A TESA is not precise enough to find sperm in men who have non-obstructive azoospermia (NOA). These men require a microdissection testicular sperm extraction (mTESE).
A TESA is done at AART under local anesthesia with or without sedation. Any sperm found at the time is frozen for later use.
Transrectal Sperm Aspiration
A Transrectal sperm aspiration is a procedure used to extract sperm in men who have an ejaculatory duct obstruction (EDO). These men typically have obstructive azoospermia, or severe asthenozoospermia (very poor sperm motility). This procedure is done using a transrectal ultrasound probe to visualize the seminal vesicles. In men with EDO, the seminal vesicles will be dilated and easy to see on ultrasound. A very small needle is then used to aspirate semen from the seminal vesicles, which will contain sperm if EDO is present. This sperm can then be frozen and used later in an IVF/ICSI cycle.
This procedure is well-tolerated, and recovery is fairly quick. Common side effects include temporary blood in bowel movements, blood in the semen, blood in the urine and rarely, infection. These side effects typically only last for 1 week.