Male Fertility Specialists in San Diego

When Sperm Retrieval is the Solution
Sperm is not always present in the ejaculate (azoospermia). Using today's minimally invasive techniques, sperm can be obtained from men with vasectomy; failed vasectomy reversal, absence of the vas deferens, or uncorrectable blockages anywhere along the seminal tract (obstructive azoospermia). In addition, it is able to retrieve and use sperm when sperm production is so low that there is not enough to make it to the outside world (non-obstructive Azoospermia or NOA).

Sperm Retrieval Techniques (MESA, PESA, TESE)
There are a number of different sperm retrieval procedures, each with potential benefits and drawbacks. Therefore, the one chosen has to be tailored to the couple’s specific needs.

Watch Dr. Bastuba perfoming a microsurgical testicular sperm extraction - click here for our online video in broadband (click here for 56k version)

PESA
Percutaneous Epididymal Sperm Aspiration (PESA) uses a needle to penetrate the scrotal skin and draw a small amount of sperm from the epididymis while Percutaneous Testicular Biopsy (PTBX) removes small cores of testes tissue.

MESA, TESE and MicroTESE
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
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.

The Procedure
Sperm retrieval procedures do not require an overnight hospital stay and last about one hour. The techniques are typically done at an outpatient surgery center though sometimes an office setting is adequate. Local anesthetic, IV sedation or general anesthesia provide complete pain control during the procedure. Due to the superficial nature of these procedures, patients routinely return back to desk type work in a day or two and disruption of normal activities is quite limited. Patient comfort and technical perfection are paramount.

Watch Dr. Bastuba perfoming a microsurgical testicular sperm extraction - click here for our online video in broadband (click here for 56k version)