How is sperm collected for IVF and ICSI?

Introduction

Why sperm collection is necessary for IVF and ICSI

In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are two popular fertility treatments that are used to help couples conceive. In both cases, the success of the procedure depends on the quality and quantity of the sperm used to fertilize the eggs. For this reason, sperm collection is an essential part of the IVF/ICSI process and testing that should be performed prior to starting treatment.

Different sperm retrieval procedures available

There are several different sperm retrieval procedures that can be used to collect sperm for IVF and ICSI. These procedures are designed to collect sperm directly from the testicles or epididymis when there is a problem with the production, transport or ejaculation of sperm. Some of the most common sperm retrieval procedures include:

• Testicular sperm aspiration (TESA)
• Percutaneous epididymal sperm aspiration (PESA)
• Microdissection testicular sperm extraction (micro-TESE)

Each of these procedures has its advantages and disadvantages, and the right one for you will depend on your individual needs and circumstances. In the next sections, we will discuss each of these sperm retrieval procedures in more detail to help you understand which one might be best for you.

Testicular Sperm Aspiration (TESA)

What is TESA and how it is performed?

Testicular Sperm Aspiration (TESA) is a procedure where a small needle is used to aspirate tissue from the testicles to collect sperm for use in IVF or ICSI. The procedure is typically done under local anesthesia and takes around 30 minutes. The collected tissue is then examined under a microscope to isolate the sperm.

Conditions that may require TESA

TESA may be necessary in cases where there is a blockage in the vas deferens, which prevents sperm from being released during ejaculation. Other conditions that may require TESA include:

• Non-obstructive azoospermia, where the testicles do not produce enough sperm
• Cancer treatment, which can damage the testicles and reduce sperm production
• Genetic disorders that affect sperm production

Advantages and disadvantages of TESA

Advantages of TESA include:

• Relatively low cost compared to other procedures
• Can be done quickly and does not require a separate surgical procedure
• Allows for the collection of viable sperm in cases where other methods are not feasible

Disadvantages of TESA include:

• Not a guaranteed source of sperm, as there may not be enough viable sperm in the collected tissue
• Risk of bleeding or infection
• Possible discomfort or pain during or after the procedure

TESA may be a suitable option for couples facing infertility, but it is important to discuss the risks and benefits with a medical professional to determine if it is the right choice for their specific situation.

Percutaneous Epididymal Sperm Aspiration (PESA)

When other sperm retrieval procedures fail, percutaneous epididymal sperm aspiration (PESA) can be performed. PESA is a minimally invasive procedure that retrieves sperm from the epididymis, the tube that carries sperm from the testicles to the vas deferens.

What is PESA and how it is performed?

PESA is performed by inserting a needle directly into the epididymis, which is located in the scrotum. Once the needle is inserted, suction is used to extract sperm from the epididymal tubules. The procedure is usually done under local anesthesia and takes about 15 to 30 minutes.

Conditions that may require PESA

PESA is often used when TESA fails to retrieve sperm or in cases where there is a blockage in the vas deferens preventing sperm from being ejaculated normally.
Other conditions that may require PESA include congenital absence of the vas deferens, previous vasectomy, and epididymal obstruction due to infection or injury.

Advantages and disadvantages of PESA

Advantages of PESA include:

• It’s a minimally invasive procedure and does not require general anesthesia.
• PESA can be performed even when sperm is not present in the semen or when there is very little sperm in the semen.

Disadvantages of PESA include:

• It may retrieve fewer sperm than other procedures and may require multiple attempts.
• PESA is also associated with a higher risk of bleeding, infection, and damage to surrounding tissues compared to other sperm retrieval procedures.

It’s important to consult with a fertility specialist to determine the most appropriate sperm retrieval procedure based on individual circumstances.

How sperm is collected for IVF and ICSI

After sperm retrieval, the collected sperm needs to be prepared for use in IVF or ICSI. The preparation process involves the following steps:

• Semen analysis: The semen sample is analyzed to determine the sperm count, motility, and morphology. This information is used to determine the best preparation technique for the collected sperm.
• Semen washing: This process involves separating the sperm from the seminal fluid. The seminal fluid contains chemicals that can damage the sperm and interfere with fertilization.
• Sperm selection: In some cases, sperm selection is necessary to ensure that only the healthiest and most motile sperm are used for IVF or ICSI. Techniques such as density gradient centrifugation, swim-up, or magnetic-activated cell sorting (MACS) can be used for sperm selection.

Techniques used to prepare sperm for IVF and ICSI

There are several techniques used to prepare sperm for IVF or ICSI, including:

• Density gradient centrifugation: This technique involves layering the sperm sample on top of a density gradient medium and centrifuging it. The sperm with the best motility and morphology move to the bottom of the tube, while the poorer quality sperm remain on the top. The bottom layer is then collected and used for IVF or ICSI.
• Swim-up technique: This process involves adding the sperm sample to a culture medium and incubating it. The healthy, motile sperm swim up to the top of the culture medium and are then collected for IVF or ICSI.
• Magnetic-activated cell sorting (MACS): This technique involves using magnetic beads coated with antibodies that bind to unhealthy or abnormal sperm. The beads and attached sperm are then removed with a magnetic field, leaving only the healthy sperm for IVF or ICSI.
• Testicular sperm extraction (TESE): In cases where sperm cannot be obtained through ejaculation, TESE may be performed. This procedure involves extracting sperm directly from the testicles and can be used in combination with ICSI.

The selection of a specific technique depends on several factors, such as the quality of the sperm sample, the patient’s medical history, and the fertility clinic’s preferred method of sperm preparation. The goal of the sperm preparation process is to obtain the healthiest and most motile sperm for use in IVF or ICSI.

Conclusion

Let’s recap the different sperm retrieval procedures that we covered in detail:

• Testicular Sperm Aspiration (TESA)
• Percutaneous Epididymal Sperm Aspiration (PESA)
• Microdissection Testicular Sperm Extraction (microTESE)
• Electroejaculation

Each of these procedures is uniquely suited for certain conditions and may have different advantages and disadvantages. It is essential to work closely with your doctor to determine which procedure is best for your specific situation.

We understand that infertility can be a challenging, financial commitment, and emotional journey for couples. However, we want to offer hope and encouragement that with the right diagnosis, treatment, and support, many couples can achieve their dreams of starting a family. Remember, you are not alone, and many resources and support networks are available to help you on this journey. Always consult with a physician so you understand the potential risks and side effects of the procedure, should you have any questions regarding treatment.