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SURGICAL SPERM SEARCH IN THE TREATMENT OF MEN’S INFERTILITY – TESA, TESE
The most important development in men’s infertility after the discovery of microinjection is surgery that is applied on men who have not any sperm on their semens. Due to this method, many men who were seen as a hopeless case could have children.
The most important development after tube baby among the assisted reproductive treatments is microinjection. After a few years from the first microinjection and birth of the baby as a result of it, the surgical sperm search which creates revolution has been started to be used. Finding sperm in the testicles of a man who has not any sperm in his semen with an operation and obtain pregnancy with this sperm after microinjection have become a hope for thousands of men around the world who cannot have a child. Surgical sperm search operations which have been started to be used in our country a few years later, have provided many couples to have their own children.
What is azoospermia?
It is the situation that a man does not have any sperm in his semen and it can depend on different reasons. Some of these depend on blockage of sperm channels and no sperm production occurs in the testicles. In some cases, sperms cannot be thrown out with the semen because of the blockage in the channels. This situation is called as lack of sperm because of blockage (obstructive azoospermia). In lack of sperm because of blockage situations, small pieces are taken by entering into the channels which are blocked or testicle tissue with a thin injection. The rate of finding sperm within these pieces is close to 100%.
In situations which do not depend on the blockage (non-obstructive azoospermia), sperm production does not occur or occurs in a limited amount in certain parts. The underlying reason of non-obstructive azoospermia may be genetic and infections experienced during adolescence period may also play a role. In such a situation, the testicle biopsy is very fruitful in terms of guiding in the treatment.
What is the success rate in surgery and how is it done?
There are thousands of tiny tube-like structures within the testicular tissue. In these structures, sperm production continues at different stages. Some tubules may have no production, while others may have few sperm. This is the rationale underlying surgical sperm search methods. When a large number of pieces taken from different parts of the testis are examined, sperm cells can be found. In this method, called TESE, the probability of finding sperm varies between 25 – 60%, depending on the underlying cause. While the highest success is achieved in hypospermatogenesis cases where sperm production is very low, the chance is least in cases due to genetic disorders.
Finding sperm in previous trials in an azoospermia case does not guarantee that sperm will always be found in subsequent trials. But often success is achieved. Similarly, there is a possibility of finding sperm in a new trial according to the biopsy result in people who have not been able to find sperm by surgery before.
Once sperm is found, whether it is found in the testis or semen does not have a significant impact on the success rates of microinjection. In other words, taking the sperm from the semen, through the ducts or directly from the testis does not change the pregnancy rates and results.