patient information - surgical sperm retrieval - Plymouth Hospitals

Patient Information: Surgical Sperm Retrieval
SOUTH WEST CENTRE FOR REPRODUCTIVE MEDICINE
OCEAN SUITE - LEVEL 6
Derriford Hospital
Plymouth PL6 8DH
Tel. (01752) 763704 : Fax (01752) 763641
e-mail: jackie.waugh@phnt.swest.nhs.uk - www.derriford.co.uk/ivf
PATIENT INFORMATION - SURGICAL SPERM RETRIEVAL
An uncommon type of male infertility (1-2%) occurs when there are no sperm in the semen
(azoospermia). In half these cases sperm production in the testicles is normal but there is a
blockage, which prevents the sperm from entering the semen (obstructive azoospermia). This
may be due to failure of the sperm passages to develop (congenital absence of the vas
deferens), blockage of the tubes (epididymis, vas deferens) transporting sperm or a previous
vasectomy (male sterilisation) operation
Surgical sperm retrieval techniques are now available whereby sperm from men with
obstructive azoospermia can be removed from the epididymis or even the testicle and then
used to fertilise eggs using ICSI.
SPERM RETRIEVAL
There are 3 main methods of surgically retrieving sperm:
1. Microepidydimal Sperm Aspiration (MESA)
This technique is performed under general anaesthetic and requires an overnight stay in
hospital. A small incision is made in the scrotum to permit access to the epididymis and the
testicle. Using an operating microscope a tiny cut is made into the epididymis and the fluid
within is removed and examined to see if there are any sperm present.
If sufficient sperm cells are found they can be frozen for subsequent use in a future IVF/ICSI
cycle.
2. Percutaneous Epidydimal Sperm Aspiration (PESA)
The advantage of this technique is that it can be performed without surgical scrotal
exploration. A small needle is passed into the epididymis and fluid is removed. This procedure
can be carried out under sedation enabling you to return home the same day.
3. Testicular Sperm Extraction/Aspiration (TESE/TESA)
If sperm is not found in the fluid taken from the epididymis via either the MESA or PESA
procedure a small sample of testicular tissue can be taken. This is then examined back at the
laboratory, sperm can be extracted and either frozen or used fresh for ICSI.
There is usually a little bruising and tenderness in the scrotum for 24-48 hours after the
operation. You will usually be back to full activity within 3-5 days. Dissolving stitches are
used and healing is usually complete by 10-14 days. All surgical procedures carry a small risk
because of the anaesthesia and there may be some bleeding or a possibility of wound
infection.
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Patient Information: Surgical Sperm Retrieval
Advantages
Disadvantages
MESA
PESA
TESE/
TESA
o One study has shown fertilization
rates of 78% and pregnancy rates of
67%.
o Samples are routinely subsequently
frozen so can be used for a number
of ICSI cycles.
o Obtain sperm from men with
irreparable epididymal obstructive
problems.
o A higher concentration of sperm may
be yielded via MESA than PESA,
however no difference in fertilization
rates or pregnancy rates have been
shown.
o One study has shown fertilization
rates of 82% and pregnancy rates
of 73%.
o Cost less than MESA.
o Less invasive – less time in
hospital.
o Less risk of infection.
o
o
o
o
Less scarring.
Can be carried out the day before
oocyte recovery and incubated
overnight to be used fresh for ICSI,
the surplus sample can then be
frozen for future use.
Provides a method of sperm
retrieval if no sperm is found in the
epididymis.
There is no difference in clinical
pregnancy rate between fresh and
frozen testicular samples.
o General anaesthetic required – increased
period in hospital.
o More invasive than PESA therefore
increased risk of pain etc following the
procedure.
o More expensive than PESA.
o Higher risk of infection from open surgery
o
o
o
o
o
Possible failure to obtain sperm.
Sometime sperm does not survive the
freezing and thawing process very well and
therefore a fresh sperm retrieval may be
necessary on the day.
May not be successful for irreparable
epididymal obstruction.
No sperm may be found and female partner
may have undergone superovulation.
Some discomfort may be felt during the
procedure as done under local anaesthetic
and sedation.
o Potential risk of temporary or permanent
injury to testicles due to open biopsy.
o Risk of testicular pain and atrophy.
o Decreased number of sperm usually
retrieved than via MESA or PESA
o Lower fertilization rate and pregnancy rates
than with epidiymal sperm
o After initial extraction sperm motility is
usually decreased, incubation for 24-48
hours can increase motility prior to freezing
or ICSI.
THE FEMALE PARTNER’S TREATMENT
Ovarian stimulation and egg collection is carried out a usually few weeks after the surgical
sperm retrieval procedure or the day after if a fresh sample is to be used. The eggs are
fertilised by ICSI whereby a single sperm is injected into the egg. Once fertilised, the
embryos are allowed to develop for 2-3 days and then transferred to the womb.
CYSTIC FIBROSIS SCREENING IN CONGENITAL ABSENCE OF THE VAS DEFERENS
Two thirds of men with absent vas deferens are carriers of the recessive gene for cystic
fibrosis (CF), an illness leading to severe respiratory problems for infants. It is advised that
the men have a test for the CF gene before a MESA is carried out. If found to be positive, it is
recommended that the female partner has her CF status checked as well. If your partner is
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Patient Information: Surgical Sperm Retrieval
also found to be positive for this gene we recommend full Genetic Counselling and discussion
prior to considering treatment.
Surgical sperm retrieval procedures do not guarantee that sperm will be found.
Survival of any sperm that is retrieved during the procedure after freezing and thawing
also cannot be guaranteed.
ALTERNATIVES TO SURGICAL SPERM RETRIEVAL
As an alternative to surgical sperm retrieval donor sperm can be used for insemination.
However there is currently a national shortage of donor sperm within the UK. Please see PI
2.1 for information on donor insemination.
Y CHROMOSOME SCREENING IN PATIENTS WITH AZOOSPERMIA
In some patients who do not have some sperm in their ejaculate the cause may be due to
micro deletion of part of their Y chromosome. If sperm from such a patient is used to achieve
a pregnancy any male child will carry the same deletion.
References:
Lin YM, Hsu CC, Kuo TC, Lin JS, Wang ST, Huang KE (2000). Journal of the Formosan
medical association. Percutaneous epididymal sperm aspiration versus microsurgical
epidydimal sperm aspiration for irreparable obstructive azoospermia - experience with 100
cases.
Rosenlund B, Westlander G, Wood M, Lundin K, Reismer E, Hillensjo T (1998). Human
Reproduction 13 2805-07. Sperm Retrieval and fertilization in repeated percutaneous
epididymal sperm aspiration.
Pasqualotto F, Rossi-Ferragut L, Rocha C, Iaconelli A, Borges E (2002). Journal of Urology
167 1753-1756. Outcome of in vitro fertilization and intracytoplasmic injection of epididymal
and testicular sperm obtained from patients with obstructive and non obstructive
azoospermia.
Kwan H, Chow V, Clark A. University of British Columbia, Vancouver, Canada.
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