Surgical Testicular Sperm Extraction - The Painless Technique

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 The needle is withdrawn, and a strand of testicular tissue follows the needle on its way out.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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Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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