State-of-the-Art Sperm Retrieval with Dr. Paul Turek
With modern advances and options in sperm retrieval procedures, there is the opportunity to father a biological child even if you have been told you are infertile. Sperm retrieval is a valuable tool for men with azoospermia (i.e., little or no sperm in the ejaculate), or men who cannot ejaculate at all. The sperm can be retrieved directly from the organs within the male reproductive tract and used to achieve pregnancy with assisted reproductive technology.
Such advanced procedures require the expertise of a uniquely qualified surgeon like Dr. Paul Turek. Dr. Turek is an internationally renowned expert in male infertility who has performed thousands of sperm retrieval procedures and has both invented and studied the techniques he offers.
Achieving Pregnancy after Sperm Retrieval
Sperm retrieved from organs in the reproductive tract are not considered fully mature or fertilizable. They may be fine genetically, but they have not learned how to move, find an egg or meet and penetrate the egg. Those processes are learned as the sperm pass through the organs of the reproductive tract. Because the sperm is not fully mature, assisted reproduction through intrauterine insemination (IUI), in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is needed to result in pregnancy.
Sperm Retrieval Techniques
Among the available sperm retrieval techniques, it is difficult to determine which is “best.” The procedure suggested to you will depend on the sperm sources available and your personal preference. Dr. Turek will discuss your options at length and help you decide on the approach with which you are most comfortable.
|Vasal Asperiation||Vas deferens||Yes||Maybe||Maybe|
|Epididymal Aspiration (MESA, PESA)||Epididymis||Maybe||Yes||Yes|
|Testis (TESA, TESE, MicroTESE)||Testicle||No||Yes||Yes|
Vasal Sperm Aspiration (PVSA, MVSA)
Vasal sperm aspiration collects sperm from the vas deferens, where the most mature or fertilizable sperm is found. Sperm in the vas deferens has already passed through the epididymis, which helps with their maturation. Pregnancy can often be achieved with IUI.
This technique may be suggested to you if you have an obstruction in the reproductive tract near the prostate, or you cannot ejaculate due to diabetes or spinal cord injury.
The short, same-day procedure is performed under local anesthesia (often with IV sedation). Dr. Turek creates a small puncture in the scrotum and identifies the vas deferens. Liquid is taken from the vas deferens and inspected by an andrology laboratory for sperm. After obtaining a suitable amount of sperm, the vas deferens is closed with microscopic sutures.
The recovery period lasts about 24 hours. Complications are extremely rare.
Epididymal Sperm Aspiration (MESA, PESA)
If the vas deferens is absent or scarred, sperm can be retrieved from the epididymis. Because sperm taken from the epididymis are not as mature as vasal sperm that have traveled through the epididymis, IVF or ICSI is required to achieve pregnancy.
Like vasal sperm aspiration, epididymal sperm aspiration is a short, in-office procedure performed under local anesthesia (often with IV sedation).
In microscopic epididymal sperm aspiration (MESA), a microscope is used to help find sperm in individual epididymal tubules. With percutaneous epididymal sperm aspiration (PESA), sperm are aspirated blindly from the epididymis through the skin.
Like vasal sperm aspiration, the recovery period of epididymal sperm aspiration is about 24 hours.
Testicular Sperm Retrieval (TESA, TESE, MicroTESE)
Sperm retrieved from the testicles is less mature than sperm retrieved with other methods. IVF and ICSI is needed to achieve pregnancy.
Sperm can be retrieved from the testicles with needle aspiration (TESA) or percutaneous or open surgical biopsy (TESE). Dr. Turek prefers to removes a small amount of testis tissue nonsurgically through a small needle, or by an open surgical biopsy if needed, and the tissue is processed by an andrology lab for sperm.
Both approaches are same-day procedures performed in our office with local anesthesia (with or without IV sedation). Depending on the approach, full activity can be resumed in 24 to 48 hours.
Table 2. Motility of retrieved sperm from the vas deferens, epididymis and testis in Dr. Turek’s study.
|Aspirated Sperm||Motility (%)
|Note: these are mean values. Data from: Bachtell et al. Hum Reprod 1999, 14: 101-104.|
Streamlining the Testicular Sperm Retrieval Procedure
Amidst concerns about the invasiveness of biopsies and the risk of permanently injuring the testis, Dr. Turek invented the Sperm Mapping technique. During a 45 minute in-office procedure, Dr. Turek can confirm whether sperm are present in the testes, where they are and how much sperm is present. This information is used to create a map that guides testicular sperm retrieval. Thanks to Sperm Mapping, fewer and smaller biopsies are required to harvest enough sperm to be used for IVF or ICSI.
Contact The Turek Clinic
If you want more information about your sperm retrieval options, please contact The Turek Clinic and schedule a consultation with Dr. Turek.
- Beliveau ME, Turek PJ. Asian J Androl. 2011, 13: 225-230.
- Turek PJ. Sperm Retrieval Techniques. In: The Practice of Reproductive Endocrinology and Infertility: The Practical Clinic and Laboratory. Edited by Carrell and Petersen. 2010, Chap 29, pp. 453-465.