For patients with azoospermia, surgical sperm ( sperm Video )
harvesting techniques need to be used to retrieve the sperm. This is
called surgical sperm retrieval or recovery, and a number of methods
have been devised to recover sperm from the male reproductive tract.or
men with obstructive azoospermia,( because of duct blockage or absence
of the vas deferens) , sperm are usually recovered from the epididymis.
The original technique was devised by a urologist,
Dr Sherman Silber, who is a specialist in microsurgery. He used a method
called MESA, or microepididymal sperm aspiration, in which the scrotum
was opened, and an operating microscope used to identify the epididymal
tubules which were distended with Sperm ( Sperm Video ) . While this method was very
successful, it was very complex , since it needed an operating
microscope; and therefore very expensive as well. This is why a
gynecologist from Dubai, Dr Pankaj Srivastav, developed a very simple
and easy method to recover sperm from the blocked epidiymis. Since he
could feel the turgid epididymis, swollen with sperm, he would blindly
puncture the epididymis using a simple butterfly needle - a technique
which was very similar to drawing blood from a blood vessel ! This
simple technique is called PESA (percutaneous epididymal sperm
aspiration), in which the sperm is sucked out from the epididymis by
puncturing it with a fine needle.
This method is as effective as microsurgery to
retrieve epididymal Sperm ( Sperm Video ) ; is much easier for both the patient and the
doctor; and much cheaper as well, since the infertility specialist can
do it himself. It is also much less traumatic, since there is no need to
cut the scrotum, with the result that there is no scar at all. This is
why this is the preferred method of choice in most centers in India, UK
and Belgium.
For patients with obstructive azoopsermia in whom
sperm cannot be found in the epididymis, it is always possible to find
sperm in the testis. The easiest way to retrieve this is through TESA or
testicular sperm aspiration , in which the testicular tissue is sucked
out through a fine needle, under local anaesthesia. The testicular
tissue is placed in culture media and sent to the lab, where it is
processed. The sperm are liberated from within the seminiferous tubules
( where they are produced ) and are then dissected free from the
surrounding testicular tissue.
Using sperm from the epididymis and testis for ICSI
in order to treat patients with obstructive azoospermia is logical, and
thus conceptually easy to understand. However, surprisingly, it is
possible to find sperm even in patients who have testicular failure (
nonobstructive azoospermia) - even in those men with very small testes.
The reason for this is that defects in sperm production are "patchy"-
they do not affect the entire testis uniformly
Various methods have been devised to recover sperm
from the testes, and a fashionable method prevalent in the US today was
developed by Dr Schlegel from Cornell, in which he uses an operating
microscope to try to identify healthy testicular tissue, in the hope
that the chance of finding testicular sperm improve. However, a much
easier, kinder and simpler method has been developed by Dr Rupin Shah of
Bombay, India, where multiple needle biopsies are taken from both
testes. While this is "blind", since it's possible to sample many more
areas of the testes ( we routinely perform over 10 microbiopsies using
this technique, even from very tiny testes) this technique is at least
as effective as Dr Schlegel's in recovering testicular sperm. Moreover,
it's much less traumatic, since no blood vessels are touched, with the
result that it causes much less pain; and it can easily be repeated in a
few months if needed, because the testes are not damaged.
However, the tragedy is that many IVF clinics in the
US continue using microsurgical techniques for Sperm ( Sperm Video ) retrieval. They
claim they are better, though actually they are not ! The sad truth is
that the real reason is that they continue using these techniques is
that it allows IVF clinics and the urologists attached to them to charge
over
US $ 3000 - 5000 for each sperm retrieval procedure ! By comparison, a
PESA in our clinic costs US $ 300; and a TESA costs US $ 500 only !
Unfortunately, it's the poor infertile couples who
have to bear the added burden. |
