What is the removal of sperm?

The absence of sperm in the semen does not necessarily mean that they are not produced at all. In case of azoospermia, crypto azoospermia, necrozoospermia, and anejaculation, sperm can be identified in other locations – the testicle or epididymis – and even if in small numbers it can be detected by resorting to different techniques. Some of them allow us to retrieve sperm from the testicles (TEFNA, TESE, microTESE), others by the epididymis (PESA, MESA).

 

What are the main collection techniques associated with the removal of sperm?

  • Testicular Sperm Extraction – TESE
  • Microsurgical Testicular Sperm Extraction – microTESE
  • Microsurgical Epididymal Sperm Aspiration – MESA
  • Percutaneous Epididymal Sperm Aspiration – PESA

TESE, MESA, and microTESE are surgical procedures, while TEFNA, PESA procedures are performed by August with aspiration.

 

In particular:

  • PESA/MESA: the collection is performed with different techniques in the epididymis, a duct that is connected to the testicle.
  • TESA: sampling is done through the skin of the testis.
  • TESE: is a biopsy of the testicular tissue, a procedure to retrieve sperm from a small piece of tissue of the testicle that is surgically removed. TESE can be performed under local anesthesia, locoregional or deep sedation. The surgeon affects the tissue that covers the testicle (tunica albuginea) and takes a section of the seminiferous tubules, which is the size of an orange seed. The excised fragment is delivered in a sterile tube to a biologists for the extraction of sperm. The levy may be single or multiple in the same testicle. At our Centre we routinely perform a histological examination that allows us to put a precise diagnosis on the azoospermia and intercept occult cancers, frequent in the NOA.
  • PROS: It is a technique that is used in all forms of azoospermia and non-obstructive azoospermia. It allows recovery and cryopreservation of the greatest number of sperm.
  • CONS: surgical procedure takes place at the hospital, however the hospital provides complete rest for at least 24 to 48 hours.

 

What are the differences in sampling between the various causes of infertility?

In necrozoospermia, sperm is present when the subject ejaculates, but it is not vital, and can’t be used for assisted reproduction techniques. In such cases the only way to get viable sperm is directly from the testicle.

In anejaculation and under certain conditions, such as juvenile diabetes, neurological systemic outcomes of surgical demolition for pelvic malignancies, we resort to the levy sperm gonads.

 

Success percentages of the treatment:

In obstructive azoospermia (OA), crypto-obstructive azoospermia, necrozoospermia, anejaculation and the recovery rate of sperm has a success percentage close to100% for ICSI. In non-obstructive azoospermia (NOA) and crypto-azoospermia secretory rate of recovery of sperm has a rate of 50% success. Generally the withdrawal is made before testicular ovarian stimulation in the female partner, cryopreservation of the sperm helps save you time and avoid unnecessary hormone treatments for the woman in case of the absence of testicular sperm.

In the period 2003-2011 were carried out a total of 1142 TESE at the Humanitas Fertility Center. It is a major international case study and the results are in line with those obtained in the best international centers.

The rate of sperm retrieval in patients with non-obstructive azoospermia results to be significantly higher in Humanitas Fertility Center than those collected in a recent review of 24 clinical studies (Donoso et al., 2007 – Humanitas 381/654 vs 24 clinical studies from Pubmed 909/1838, p = 0.0001).

 

 

Cause

  

 

 

No withdrawals

  

 

 

Positive samples (%)

  

 

 

Withdrawals negative (%)

 

  

 

  

 

  

 

Necrozoospermia 
+ 
Anejaculation

    

208
 

    

208 (100%)
 

    

0
 

 
 

            

NOA

  

654

  

381 (58.2%)

  

273 (41.8%)

 

            

OA

  

280

  

279 (99.6%)

  

1 (0.4%)
 

 

 

Information for patient hospitalization:

 

What to do before admission?

The patient is required to:

  • Depilation to be made on the morning of the admission, and without the use of hair removal creams.
  • Removal of hair on the left calf.
  • Do not eat or drink after midnight, the day before the surgery.

 

What to do after discharge?

  • The patient can’t drive and therefore requires an escort for the return trip home.
  • Free diet after surgery.
  • Consume antibiotics for 5 days.
  • Consume painkillers when needed.
  • Abstinence from sexual and sport activities for 10 days
  • Swimming in a pool or the sea is strictly prohibited, up to the fall of the stiches or removal.
  • Return visit to the hospitals 10 days after the surgery.