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The best treatment choice for the man with
azoospermia ( zero sperm count) is testicular sperm extraction ( TESE)
with ICSI ( intracytoplasmic sperm injection) in which testicular sperm
are injected into the eggs in order to fertilise them. Here is a
photo-essay which describes the painless technique we use in our clinic
for extracting testicular sperm in azoospermic men when they need TESA-ICSI ( testicular sperm aspiration with intracytoplasmic sperm injection.) This method was
developed by our andrologist, Dr Rupin Shah. We call it the " Dr Shah
Needle TESA technique." Most men are understandably
scared of allowing a surgeon near their testes - and even a testis
biopsy can be a very painful experience. This revolutionary technique
allows us to extract testicular sperm, even from men with tiny testes,
without having to make a skin incision ! Not only is
this much easier for the patient, it also much less traumatic, which
means it can be repeated if needed. It is usually done under local
anesthesia. We can sample multiple areas ( needle mcirobiopsies) of the
testes with this method. If you would like to see a
closeup, please click on the thumbnail of the image of interest.
1. The testis is stabilised by stretching the skin
tightly over it.
2. A "butterfly" needle is inserted into the testes through the taut
skin. Negative pressure is applied using a 10 ml syringe.
3. Multiple passes are made into the testes with the needle, allowing us
to apply significant negative pressure to "suck" out the testicular
tubules.
4. The needle is withdrawn, and a strand of testicular tissue follows
the needle on its way out. This is pulled out gradually from the testis.
5. The strand of testicular tissue is grasped with a fine forceps.
6. This strand is pulled out gradually.
7. The tissue is then collected in culture medium. We can get a
surprisingly large chunk, with not a drop of blood, in a few seconds.
8. This tissue is then examined under the stereozoom microscope in the
IVF lab, and the tissue processed and analysed for the presence of
testicular sperm.
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