| 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.
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