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Sperm Retrieval Techniques

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 When we go to retrieve sperm from a male, first we must understand is this male producing high numbers of sperm but the system is blocked, or is he producing very low numbers of sperm. That is crucial in determining what type of procedures is used to retrieve or obtain the sperm from the male. below are some methods of sperm retrieval techniques.

» Assisted Reproduction Techniques

» ICSI (Intracytoplasmic Sperm Injection)

» Surgical Sperm Retrieval

» Microsurgical Retrieval of Epididymal Sperm

» Non-obstructive Azoospermia and TESE

» Non-Surgical Sperm Retrieval

» Congenital Bilateral Absence of Vas Deferens

» Electroejaculation

» Ejaculatory Duct Obstruction

» Percutaneous Sperm Aspiration

A. Non Surgical Sperm Aspiration 

1. Testicular Sperm Aspiration -TESA 
In TESA performed in our clinic under local Anesthesia , one can easily and quickly obtain adequate numbers of sperm for ICSI in many men who have no sperm in their semen because of vasectomy or other causes of blocked ducts; in men who cannot ejaculate including men with spinal cord injury. Men who lack living sperm in their ejaculate frequently have at least some sperm in the testicles, where sperm are made. Testicular sperm can fertilize if they are injected directly into the eggs through a process called ICSI (Intracytoplasmic Sperm Injection.)

TESA is performed under sedation, and is painless and rapid. A tiny needle is used to extract sperm directly from the testis. While the ejaculate normally contains 100 million to 300 million sperm, aspiration of as few as 100-200 sperm by NSA have been enough to achieve pregnancy when it is combined with ICSI. Prior to the development of TESA, men with no sperm in their ejaculate had to undergo surgery to remove sperm either from their testes or from tubes connected to the testis. Non-surgical sperm aspiration is rapid, does not require hospitalization, is pain-free when done under sedation, and recovery is virtually immediate. 

The technique will be immensely helpful to men who have had vasectomies and later decide that they want to have children. It is possible to reverse a vasectomy by having bypass surgery, but the operation is frequently not successful, especially for men with long-standing vasectomies. Additionally, sperm quality after vasectomy reversal is often reduced and ICSI is required even if sperm appear in the ejaculate. For many men, non-surgical sperm aspiration eliminates the need for vas reversal surgery. Men who cannot ejaculate due to spinal cord injuries or neurological conditions like multiple sclerosis can also become fathers through the new technique. There is also a large group of infertile men who simply have no sperm or only dead sperm in their semen although their ducts and ejaculatory process are normal, and who can have testicular sperm obtained through NSA. 

2. Percutaneous Epididymal Sperm Aspiration - PESA 
In this the sperms are directly aspirated with the aid of a small needle mounted on a syringe. The skin is not cut open .The aspirate is given to the laboratory, where the sperms are identified and ICSI is performed. PESA will also help infertile men who lack sperm in their semen because the route out of the testes has been blocked by prior infection or congenital lack of development (Congenital Bilateral Absence of Vas Deferens CBAVD), as well as men who have had their prostates removed and can no longer ejaculate but make sperm. 

NSA must be done with ICSI because testicular sperm cannot enter eggs by themselves. The female partner receives a series of medications to increase the number of eggs created by the ovary as in a conventional IVF cycle. When the eggs grow to adequate size, they are extracted non- surgically at the Institute under sedation, and NSA is scheduled the same day. After egg retrieval and sperm aspiration, our embryologists will inject each egg with a single sperm. Two days after the procedures, definite information regarding fertilization of the eggs and the number of embryos will be available. Embryos will be transferred back to the uterus two or three days following fertilization; additional embryos may be cryopreserved (frozen), as requested. It should be noted that for some men a single NSA procedure may yield enough sperm to permit sperm freezing for several subsequent ICSI attempts. 

B. Testicular Sperm Extraction - TESE 
There is a particular group of males who have no sperms in their semen. Also standard testicular biopsy procedure, done in the past , have shown no spermatogenic activity. In recent times, many such males, have undergone the procedure of TESE. The biopsy specimen thus obtained, has been meticulously searched for sperms, over 2 to 6 hours, sperms obtained, ICSI performed and pregnancies achieved. As many as 10 -30% men with established testicular failure, have fathered kids with this technique. We at the IVF Odisha Fertility Centre are doing all the above procedures in our lab, with a high pregnancy rate.

What is artificial insemination with Donor sample (AID) or Donor Insemination (DI)?

In as many as 30 % of infertile couples the male is responsible for infertility. A significant percentage of these males do not father children despite various treatments including ICSI. The solution is inseminating their wives with semen of another male (donor) at the time of her ovulation. This procedure is called AID or DI.

Who can benefit from AID?
1. AID (Artificial Insemination Donor ) is generally advocated for males with low semen counts (Oligospermia or zero counts) (Azoospermia), where treatment with drugs, surgery and ART treatments like AIH, IUI and ICSI have proven unsuccessful. It is an acceptable alternative to adoption.
2. It is also suggested to males who may have a genetic disorder that could get transmitted to their progeny.
3. It may be used as a backup to the procedure of TESE (Testicular Sperm Extraction) and ICSI that is done for males with non-obstructive Azoospermia, especially when no sperms are found in the testicular biopsy. (see Nonsurgical Sperm Retrieval)

How is the Semen obtained in Semen Banking?
A donor male donates the semen after he is screened and tested as safe for various infections such as HIV, Hepatitis and other Venereal Diseases. At BabiesandUs lab, we test the donor for infections every 3 months. The semen thus obtained can be used in two ways:

1. Fresh Semen Insemination:
It is insemination where the donated semen is used within an hour of ejaculation. The semen can be placed on the cervix without processing or can be placed in the womb after processing as is usually done with IUI. This is done commonly in India. However, there is always the remote chance of a donor carrying the latent infection of HIV that may manifest itself as a positive after 2 to 3 months of the insemination. It is due to these reasons many ART units have given up this technique.

2. Frozen Semen From Semen Bank:
After collecting the semen from an HIV negative donor, it is processed, added to straws or vials. These are then stored in liquid nitrogen containers called semen banks, of -196ºC for six months. In short, it is quarantined. After 6 months the donor is retested for HIV. If the second HIV test is negative, this sample is released from quarantine and insemination takes place only at that time.

Which of the two is a better alternative?
The success rate of both fresh as well as frozen AID is almost similar. However in case of frozen AID it is important to accurately pinpoint the timing of ovulation. This is because the motility of frozen thawed sample decreases rapidly within 12 hours, in contrast to fresh insemination, where the sperms stay alive in the body for 48-72 hours.However, the biggest advantage of frozen samples are its minimal risk of HIV transmission.

What is the Success rate of AID (Artificial Insemination Donor) ?
The success rate is in the region of 15-20%. That means if 10 couples undergo AID every month, 1 or 2 couples would become pregnant every month. At the end of 6 months 5 to 6 couples become pregnant. The remaining 4-5 couples who do not become pregnant, can undergo further AID for 6 months. During this time 2 more will become pregnant. At the end of one year around 80% (8 out of 10 started couples)will acheive pregnancy. The two couples who fail to become pregnant at the end of one year can either opt for IVF/ICSI with donor sperm or go in for adoption.

Read 720732 times Last modified on Friday, 01 June 2012 05:22

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Team IVF Odisha

drpltripathy
Dr. P. L. Tripathy
Obstetrician & Infertility Specialist
  • Dr. Neeraj Pahlajani
    Obstetrician & Infertility Specialist

    dr sameerpahlajaniDr. Sameer PahlajaniInfertility Consultant & Sonography ExpertDr Dibyajit_MohantyDr. Dibyajit MohantyMD, Obs. & GynecDr Sasmita_DasDr. Sasmita DasMD, Obs. & Gynec