These procedures have effected a revolution in the treatment of male infertility for men with azoospermia, the condition characterized by an absence of sperm in the semen. success rates are high and the results are gratifying.
Continued advances in the treatment of male infertility have brought the joy of parenthood to couples that have struggled for years to have a baby. Premier Medical Group’s Jason Krumholtz, M.D., is happy to be a part of this development.
Approximately 20 percent of all cases of male infertility are caused by azoospermia, a condition characterized by the absenceof sperm in the semen. There are two main types of azoospermia, obstructive and non-obstructive. Men with obstructive azoospermia produce sperm, but they are not released into the semen because of a blockage in the reproductive system. In non-obstructive azoospermia, sperm are not being produced in the testes or are present in levels too low to effect reproduction.
In these cases, Dr. Krumholtz will identify the cause of the azoospermia and then proceed to treat the underlying problem. In many men, the problems can be corrected by targeting therapy at the anatomical, hormonal, and pathophysicologic causes of the condition. Nonetheless, there is a group of men whose azoospermia is uncorrectable and they, and their spouses, will need to pursue in vitro fertilization (IVF).
IVF requires a very small number of sperm to fertilize an egg through a process called intracytoplasmic sperm injection (ICSI). Testicular sperm extraction (TESE) and testicular sperm aspiration (TESA) are procedures that retrieve sperm from a patient’s testes to make assisted reproduction possible and successful.
In the standard TESE procedure, a small incision is made in the testes to retrieve sperm that can be used—either fresh or cryopreserved (frozen)—for in vitro fertilization (IVF). Standard TESE generally takes 30 minutes and can be performed in the office with local anesthesia. The recovery
time is typically two or three days.
A variation of the technique, micro-dissection testicular sperm extraction (Micro-TESE), is appropriate for patients with non-obstructive azoospermia. These men produce so little sperm that none of it is detected in the semen. The procedure is performed in the operating room, using a high-powered operative
microscope. Dr. Krumholtz opens the outer cover of the testicle and examines the testicular tissue for tiny areas of healthy tissue that may produce sperm. He then examines the tissue in the operating room, using a standard light microscope. He will continue to search and, if necessary, move to the other testis until
sperm is identified. The tissue is transported to a reproductive endocrinologist who processes the tissue the same day. Given the limited quantity and fragility of the extracted sperm, IVF must be performed within 24 to 48 hours of extraction.
A dream come true
“For many years it was thought that men who have zero sperm were candidates for nothing but adoption or would require sperm donors, but these techniques have really revolutionized infertility treatment—and have done so with high success rates,” Dr. Krumholtz says. In fact, in patients with obstructive azoospermia, the ability to obtain sperm is nearly 100 percent.
He cautions, however, that infertile men should not expect to immediately opt for TESE or TESA. “We do not just jump to these procedures,” Dr. Krumholtz stresses. “Very often we can determine through blood work, hormone testing and imaging that the cause is correctable.”
For men with uncorrectable azoospermia, however, TESE and TESA can literally make dreams come true. “Unfortunately, it is fairly common for couples to have been trying for years to have a baby before they pursue this avenue,” Dr. Krumholtz says. “Many couples don’t know these procedures are available, which is why it is important to seek help from professionals who deal with infertility on a regular basis.”