Testicle biopsy for male infertility

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During a comprehensive examination of couples suffering from infertility, the diseases of the stronger sex are increasingly found. One of them is azoospermia, during diagnostics of which the absence of spermatozoids in the ejaculate is detected.

The method of intracytoplasmic injection of a single spermatozoid (better known as ICSI) has made a revolutionary breakthrough in treatment of male infertility. The city of Brussels had the honor to be the first to see the birth of the child conceived in this manner. However, in order to conduct the ICSI procedure, it is required to obtain a spermatozoid from a testicle by surgery.

Indications for testicular biopsy (TESA):

  • non-obstructive azoospermia is described as the absence of sperm in the ejaculate. This genetic anomaly (Klinefelter syndrome, cryptorchidism, testicular torsion) is manifested as a violation in the system producing the spermatozoids in the testes.
  • obstructive azoospermia occurs when the sperm production in the testes follows the natural cycle, and the reasons for the absence of spermatozoids in the diagnostic spermatogram material is mechanical obstruction. It may occur after treatment of inguinal hernia by surgery, bilateral aplasia or vasectomy.
  • obstructive (mechanical) aspermis is characterized by obstruction of spermatic cord in the background of normal development of the male sex cells.


TESA (testicular sperm aspiration)

This is a method, which has proven to be the gentlest method of obtaining spermatozoids. It has been used since 1997. The main obstacles to the method success are the following diseases: tubular obstruction or absence of spermatogenesis foci.

The manipulations during spermatozoid aspiration from testicular tissue are carried out using the regional anesthesia (in rare cases, a general anesthesia), without cutting the shells (scrotum). The essence of this method is described as aspiration of testicular tissue through a fine needle inserted into the testicle through the skin, so that all conventional segments of the testis were subject to biopsy. The content of the syringe is immediately examined under a microscope to search for the sperm.

It is allowed to carry out 5 to 6 such manipulations, but when no spermatozoid is detected, it is proposed to conduct the following manipulation options.

TESE (testicular sperm extraction)

This method was proposed in 1993, and won the championship by effective combating of non-obstructive azoospermia as a cause of male infertility. This manipulation is performed by testicular biopsy, followed by spermatozoid extraction from the resulting tissue and oocyte fertilization.

PESA (percut aneous epididymal sperm aspiration)

Since 1993, PESA method took its deserved place as the one recommended for use to combat the male infertility. Manipulation involves the use of the regional (seminiferous tubule), and rarely general anesthesia, without dissecting the scrotum shells. During a needle biopsy, the specialist punctures the epididymis with the thinnest needle and extracts sperm from it. This manipulation for the diagnosis of obstructive azoospermia ensures up to 100% method efficiency.

MESA (microsurgical epididymal sperm aspiration)

This is one from the first method, developed yet in 1985, which after 9 years was used as a part of a comprehensive ICSI program. Typically, the procedure requires general anesthesia; there are more rare cases of applying the regional anesthesia, since the procedure is an open surgery. This manipulation implies a single or multiple biopsies of the epididymis, followed by spermatozoid extraction from the resulting liquid.

MESA technique can only be used by a high-skilled microsurgeon, and this is why it is often inferior to PESA method.

If the use of the above techniques didn’t allow obtaining the required spermatozoids, which can be used during in vitro fertilization programs, then the doctors recommend the use of the donor sperm.

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