SPERM CELL COLLECTION WITH WITH EPIDIDYMIS OR TESTES BIOPSY

Surgical sperm retrieval (TESE)

Surgical sperm retrieval is recommended in cases of azoospermia, inability to ejaculate, or failure of induced ejaculation by electrostimulation. The procedure is performed under intravenous or local analgesia. The testicular tissue obtained is specially processed by the embryologist to find sperm. Once motile sperm have been isolated, the eggs are fertilised by microinjection (ICSI). Any surplus sperm can be frozen for future use. There are various methods of surgical sperm retrieval, either from the epididymis or from the testes.

Sperm retrieval from the epididymis

• Microsurgical epididymal sperm aspiration (MESA): Recommended in cases of obstructive azoospermia with normal sperm production. It involves surgically opening the epididymis under a microscope and aspirating the epididymal fluid to find sperm.
• Percutaneous epididymal sperm aspiration (PESA): Recommended in cases of obstructive azoospermia with normal sperm production. It is performed by puncturing the epididymis with a 19-21G needle.

Sperm retrieval from the testis

• Fine needle aspiration (FNA): Recommended in cases of obstructive azoospermia with normal sperm production. It is performed by puncturing the testis with a fine 21G needle.
• Testicular sperm aspiration (TESA): Recommended in cases of obstructive azoospermia with normal sperm production.
• Testicular biopsy (testicular sperm extraction – TESE): Recommended in cases of obstructive and non-obstructive azoospermia; it involves an open biopsy and the collection of small pieces of testicular tissue.

Methods that aspirate sperm from the epididymis (MESA, PESA) or the testes (TESA) are simpler, but they are largely "blind" and cause damage to the testicular tissue, such as haematoma, fibrosis and testicular atrophy. The international literature recommends testicular biopsy (TESE) as the most effective method of finding sperm, and it is associated with a lower complication rate.