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Testicular Sperm Aspiration

Extraction of sperm from seminiferous tubules & Cryopreservation freezing.
We have been performing testicular aspirations at the Wesley Hospital since October, 1994. This allows sperm to be retrieved from men who have no sperm in their ejaculate (i.e.. azoospermia). This situation is usually caused by two main problems, (1) Obstructive azoospermia and (2) Spermatogenetic failure.

Normally the seminiferous tubules in the testes produce large numbers of sperm which undergo a maturation process as they leave the testes and pass through the epididymis, thus acquiring motility and the ability to interact with the egg to achieve fertilisation.

Obstructive azoospermia (lack of sperm in the ejaculate due to obstruction) is usually due to vasectomy and failed attempts at vasectomy reversal, congenital absence of the vas deferens and adhesions due to infection. In obstructive azoospermia, the seminiferous tubules usually continue to produce fair quantities of sperm.

Men with spermatogenetic failure and azoospermia have an arrest in the development of sperm from the germ cells and often have a raised follicle stimulating hormone and smaller testes. However, small areas of spermatogenesis can still be present from which immature sperm can be aspirated. It is thought that the sperm produced in these areas are either not released into the inside of the seminiferous tubule or are absorbed in transit through the epididymis.

Technique

The technique used for testicular aspiration is quite simple and relatively free from complications. The patient will require a local anaesthetic. A small needle is inserted just below the surface of the testis and a small piece of testis containing seminiferous tubules is drawn out. Our scientists then extract sperm from the tubules before injection by the ICSI technique into the wife's oocytes (eggs). The sperm obtained from the seminiferous tubules are immature but are still functional and capable of forming normal embryos and proceeding to normal pregnancies.

Complications & Risks

- There have been some cases of serious testicular damage recorded in the literature, such as haemorrhage and atrophy of part or all of the testis, but this appears to be related to deep penetration of the testis by the biopsy needle. This is not done in our unit, as only superficial punctures of the testes are performed and to date we have not noted any long-term problems in over 200 patients who have had the procedure at the unit.

- Minor complications can occur such as local tenderness and swelling in the testis. In most cases this does not last more than 48 hours and does not appear to restrict normal activities.

Freezing

The unit has successfully developed a treatment protocol of freezing and then thawing sperm within the seminiferous tubules that are aspirated from the testes during the testicular aspiration. This technique reduces the need for repetitive testicular aspirations and increases the likelihood of sperm availability on the day of the egg retrieval. It would appear that there is some factor within the seminiferous tubules that protects the immature sperm during the freezing and thawing process.

However, the freezing and thawing of sperm in the tubules is not always successful and therefore on the day of the wife's oocyte retrieval, the husband will be on standby in case a fresh testicular aspiration is required.

Success Statistics

Our statistics for testicular aspirations have been very encouraging. Currently our scientists are achieving fertilisation rates of over 60% with fresh testicular aspirated sperm injected by the ICSI technique into the partner's oocytes.

The fertilisation rate using thawed testicular sperm is approximately 55% compared to 60% using fresh testicular sperm. The Wesley IVF unit was the first unit in the world to achieve a pregnancy using aspirated sperm which was frozen using the new technique.

Currently the pregnancy rate using both fresh and frozen testicular aspirated sperm is 23%.

It would appear that provided fertilisation occurs with resultant embryo development, normal pregnancies will result from testicular aspirated sperm.

It is advised that the wife proceeds with an ICSI IVF cycle within 6 months of the seminiferous tubules being frozen.

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