Treatments For Men Who Do Not Produce Sperm In The Ejaculate
In Vitro Fertilization (IVF) is the treatment of choice for moderate or severe male infertility. Even men who have had a previous vasectomy are may prefer Intracytoplasmic Sperm Injection (ICSI) done in combination with Testicular Sperm Extraction (TESE), to surgical vasectomy reversal.
Although always a treatment of choice for male infertility, it was not until the introduction of ICSI that IVF became just as successful when applied in cases of male infertility, as for female related causes. ICSI is a procedure where fertilization is achieved through the direct injection of a single sperm into the cytoplasm of each mature egg.
Testicular Sperm Extraction (TESE) And Intracytoplasmic Sperm Injection (ICSI)
TESE is a procedure involving the introduction of a thin needle directly into the testicle(s), under local anesthesia or conscious sedation, without making a skin incision. Hair-thin specimens of testicular tissue are removed (usually under local anesthesia) in the space of 15 to 30 minutes. Sperm are extracted from the tissue and each egg is injected with a single sperm using the ICSI technique. It may be necessary to perform several attempts in each testicle until viable sperm are positively identified under the microscope. If necessary a small suture is placed into the scrotal skin and an ice pack is applied onto the scrotum.
Sperm can be retrieved in excess of 90% of cases. Usually in those cases where sperm are not retrieved, the male has oligospermia (low sperm count) or intra-testicular pathology. If sperm are recovered, the fertilization rate is 50-60% of the eggs, when ICSI is performed in IVF centers of excellence. The anticipated birth rate per TESE with /ICSI procedure performed in cases where the woman is <40yrs is about 50% (i.e., no different than conventional IVF birthrates in women of comparable age).TESE is simple, relatively low-cost, safe, and virtually pain-free. Most men can literally take off a few hours for the procedure and return to normal activity straight away.
Aside from the remarkable success rates with TESE/ICSI is the fact that, unlike vasectomy reversal, the procedure allows the man to retain his vasectomy for future contraception.