ICSI Sperm Retrieval
Intracytoplasmic injection (ICSI) is an advanced IVF method whereby a single sperm cell is injected directly into an egg cell, thereby increasing the chances of successful fertilization. As part of the ICSI procedure, an embryologist examines a man's semen sample under a microscope and selects the very best quality sperm cells for the fertilization attempt. This technique has helped men who have poor quality sperm, or low sperm counts in their semen, to become fathers.
But what about men who are unable to ejaculate naturally, or who have next to no active sperm cells in their semen? Well, ICSI can help these men too, but it may be only in combination with sperm retrieval techniques.
Removal From The Testes
Basically, if a man is unable to produce semen containing sperm, the sperm cells can be removed directly from his testicles (providing that his testicles do have some level-low sperm producing function). The method used to take sperm from the testes will depend on the man's particular problem (whether he has a blockage in his testicles and therefore can't ejaculate, or whether he can ejaculate but his semen contains only extremely small numbers of sperm).
Microsurgical Epididymal Sperm Aspiration is a technique in which a very small cut is made in the skin of the scrotum, and active sperm cells are aspirated (or sucked out) of the small tubes in the skin.
Percutaneous Epididymal Sperm Aspiration is a technique similar to MESA, except that a very fine needle is passed all the way through the skin of the scrotum and into the epididymis beneath. The needle is used to suck out sperm cells.
Testicular Sperm Aspiration is a slightly more invasive method of sperm retrieval. It basically involves a needle biopsy. The needle is inserted repeatedly into the testicle (i.e. through the scrotal skin and the epididymis) and retrieves tiny amounts of testicular tissue. If all goes well, an embryologist can retrieve sperm cells from this tissue.
Testicular Sperm Extraction involves cutting small pieces of tissue out of the testicle itself, after an incision has been made in the scrotal skin for access. An embryologist then takes the tissue and divides it up into smaller and smaller pieces, looking for sperm cells in the small tubes inside the tissue.
Testis Percutaneous Biopsy
This method is similar to TESA, but uses a larger biopsy needle in an attempt to retrieve a larger number of sperm cells.
This is probably the most invasive sperm retrieval technique. It's usually performed only on men who have very low levels of sperm production going on inside their testicles. A cut is made in the skin of the scrotum to provide access to the testicle. Under a microscope, the testicular tissue is then "searched" for any sperm cells that may be present.
No man can be criticized for wincing a little when he reads about these techniques. However, they are all performed under adequate amounts of anesthetic and/or sedation, and the experts have already had plenty to time to perfect their methods. If you're considering sperm retrieval methods in combination with ICSI, it's important to focus on the long term goal of becoming a Dad, rather than the short term discomfort you may feel.