In case no sperm is detected in the semen (azoospermia) or the DNA fragmentation index (DFI) is high or if sperm is immotile and one can’t tell whether it’s alive, the techniques of testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA) are available. Moreover, there is the surgical method of testicular sperm extraction (TESE).
Mr. Evripidis Mantoudis has cooperated with Professor Ian Craft in London, a pioneer in the field of IVF in general, namely regarding PESA. In the clinic of Professor Craft, PESA has been used in a very large number of patients.
PESA aims at aspiring fluid from the epididymis (where sperm is stored, ready to be ejaculated) and is recommended in cases of obstructive azoospermia (when there is an anatomical reason impeding sperm release in the semen). Aspiration is performed with the use of a fine needle, under local anaesthesia and mild intravenous sedation, in order for the patient not to feel any pain. Besides, no surgical section is performed during PESA, which means that the patient feels no pain after the procedure.
The disadvantage of this method is that usually only a small amount of fluid from the epididymis is aspirated, which is sufficient for one IVF cycle, but not for cryopreservation and use in future cycles. Thus, in case of a new IVF cycle, PESA must be repeated. It is less costly though than open surgery.
If PESA fails, i.e. if no sperm is detected in the epididymal fluid, TESA can be applied, i.e. tissue can be aspired directly from the testicles. In parallel, the tissue undergoes histological analysis, to detect the reasons of infertility.
Alternatively to aspiration methods with the use of a fine needle, there are also surgical techniques, such as MESA (microsurgical epididymal sperm aspiration) or TESE, retrieving sperm from the epididymis or the testicles, respectively. The advantage of these methods is that sufficient sample is collected to be used in several IVF cycles (with cryopreservation). However, the patient’s recovery takes several days (from 1-2 days to 1 week), because these techniques include surgical sections (stitches are performed for recovery). Moreover, these surgical techniques must be performed by an experienced and specialised doctor, so that the possibility of a temporary or permanent damage in the man’s reproductive system is minimised. In some cases though, this is the only solution.
The above methods are perfectly combined with intra – cytoplasmic sperm injection (ICSI), during which only one sperm is needed for each oocyte’s fertilisation. For ICSI, even immature sperm or sperm with low motility can be used, because it doesn’t need to move towards the oocyte to fertilise it.
Techniques of sperm retrieval from the epididymis or the testicles in combination with ICSI have been applied with excellent results and have offered a solution in cases of severe male infertility. Fertilisation and pregnancy rates are quite high and numerous babies across the world, including Greece have been born after such infertility treatments.