MICRODISSECTION TESTICULAR SPERM EXTRACTION (mTESE)
Microdissection testicular sperm extraction (mTESE) is a surgical procedure used to extract sperm from inside the testicles. It is used in individuals 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. It affects approximately 1% of men in Canada.
A MicroTESE allows an individual who otherwise would not be able to conceive a 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 urologist or infertility doctor. To increase 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 the Dartmouth General Hospital. The goal is to find small islands of preserved sperm production 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 urology, infertility and microsurgery. Recovery time afterwards is approximately 2 weeks.
VASECTOMY REVERSAL OR VASOEPIDIDYMOSTOMY
A Vasectomy reversal is an excellent option for an individual 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 urology 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 3-4 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, an individual 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 individuals who have had a vasectomy within 10 years will be able to have a vasectomy reversal, but rarely, those who have had their vasectomies a long time ago will need a vasoepididymostomy 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 that is linked on our website under “Fertility Services for Individuals with Sperm” published by Dr. Ory.
PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION (PESA)
PESA is a surgical procedure used to extract sperm from inside the epididymis. This is done for individuals with obstructive azoospermia (OA). OA most commonly happens in individuals after a vasectomy, but can also occur with certain infections that scar down the vas, or in individuals with cystic fibrosis. If an individual is 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 Atlantic Fertility 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 the testicle. This is usually done if the diagnosis of non-obstructive azoospermia or obstructive azoospermia is unclear. It is also frequently performed if an individual 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 individuals who have non-obstructive azoospermia (NOA). These individuals require a microdissection testicular sperm extraction (mTESE).
A TESA is done at Atlantic Fertility 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 from individuals who have an ejaculatory duct obstruction (EDO). These individuals typically have obstructive azoospermia, or severe asthenozoospermia (poor sperm motility). This procedure is done using a transrectal ultrasound probe to visualize the seminal vesicles. In individuals 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.