Sperm Retrieval Including Microdissection Testicular Sperm Extraction

Sperm retrieval is used for men who have low sperm count and would like to use their own sperm to fertilize their partner's egg.  There are several different techniques that Dr. Lerner uses to retrieve sperm in men who have testis failure or obstruction azoospermia from either a prior vasectomy or an infection.  They include:

Testicular sperm aspiration (TESA)
Testicular sperm aspiration (TESA) is a procedure performed for men who are having sperm retrieved for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).  It is performed with local and or sedation anesthesia in the operating room or office.  It can be performed as a schedule procedure prior to IVF or can be coordinated with their female partner's egg retrieval.  A needle is inserted in the testicle and tissue/sperm are aspirated.  TESA is performed for men with obstructive azoospermia.  Sometimes, TESA doesn't provide enough tissue/sperm and an open testis biopsy is needed.

Percutaneous Epididymal Sperm Aspiration (PESA)
Percutaneous Epididymal Sperm Aspiration (PESA) is a procedure performed for men who are having sperm retrieved for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) who have obstructive azoospermia from either a prior vasectomy or infection.  It is done with local and or sedation anesthesia in the operating room or office.  It can be performed as a separate procedure prior to IVF or can be coordinated with their female partner's egg retrieval. 

Testicular sperm extraction (TESE)/Testis biopsy/Testis mapping
TESE/testis biopsy/testis mapping are procedures performed for men who have testis failure or in men with obstruction who cannot have sperm retrieved by aspiration.  It can be performed as a scheduled procedure or is coordinated with their female partner's egg retrieval.  TESE is usually performed in the operating room with sedation, but can also be done in the office with local anesthesia alone.  Patients usually cryopreserve sperm during this procedure for future IVF/ICSI.  This diagnostic biopsy is usually performed to evaluate for an obstructive etiology; however, microdissection TESE has replaced this as the optimal form of retrieval for azoospermic patients.

Microepididymal Sperm Aspiration (MESA)
MESA is a procedure performed for men who have vasal or epididymal obstruction following vasectomy.  It is either done as a scheduled procedure or is coordinated with their female partner's egg retrieval.  MESA is performed in the operating room with general anesthesia under the operating microscope.  Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. 

Microdissection TESE (MicroTESE or Microdissection Testicular Sperm Extraction)
Microscopic TESE is a procedure performed for men who have testis failure.  Microdissection TESE is performed in the operating room with general anesthesia under the operating microscope, and is performed fresh at the time of egg retrieval for IVF.  The sperm found in men with testis failure needs to be used as soon as possible from the time of retrieval, as it doesn't survive the cryopreservation process.   Microdissection TESE can improve sperm retrieval for men with non-obstructive azoospermia (a sperm production problem) over those achieved previously with standard testis biopsy techniques.  Further, sperm can be found in up to 60 percent of patients.