In severe cases of male infertility such as anejaculation, the absence of sperm on a semen analysis may be due to azoospermia, congenital bilateral absence of the vas deferens, vasectomy or no viable sperm after ejaculation. To overcome severe male infertile problem there are treatment options depending on the sperm source available and patient preference such as the following:
Sterile male partners can have children by using medical advances and a number surgical techniques developed to collect sperm from testicles or other parts of the vas deferens as follows:
PESA (Percutaneous Epididymal Sperm Aspiration) is the method of puncturing the skin of the testicles with a needle into the epididymis and extracting sperm. After acquiring one viable sperm, the sperm will be used to penetrate the oocyte by using a micromanipulator. This method is called ICSI (Intracytoplasmic Sperm Injection).
TESE (Testicular Epididymal Sperm Extraction) is surgery performed to obtain a small piece of testicular tissue and separating the sperm in the testicular tissue for use in ICSI.
TESA (Testicular Sperm Aspiration) is the method of puncturing skin of the testicles with a needle inserting it into a testicle to extract sperm for use in performing ICSI.
MESA (Microsurgical Epididymal Sperm Aspiration) is the surgical method of making an incision to reach the epididymis and using a needle to extract the sperm before performing ICSI.
Generally speaking, sperm extraction surgery is considered a safe process offering infertile persons more hope and treatment options. According to current data, the rates for abnormalities and disabilities for infants resulting from surgery to obtain sperm by the aforementioned techniques are no different from the rates of abnormality found in the general population.
All of these methods require basic supporting technology consisting of ICSI and culture, including ICSI expertise.