Techniques for obtaining spermatozoa

There are currently many different solutions when spermatozoa are not present in ejaculate. Access to a trained urologist increases chances of achieving spermatozoa in greater quantities and with improved quality.

What is TESA (Testicular Sperm Aspiration)?

This is a question which many couples ask themselves as they turn to assisted reproduction treatment when the issue is an absence of spermatozoa in semen (azoospermia) with the aim of obtaining sperm. TESA (Testicular Sperm Aspiration) is a technique used for obtaining spermatozoa by testicular puncture.

Modern-day urology means that spermatozoa can be obtained for use in assisted reproduction techniques using different means. Over the last 10 years, we have improved the chances of achieving good results whilst reducing the invasive nature of the process and improving the quality of samples obtained in cases in which this was not previously possible. Men who have undergone a vasectomy, cases in which the sperm duct is obstructed or patients with cystic fibrosis are common examples in which adequate spermatozoa may be obtained through a simple testicular puncture under local anaesthetic. Different types of biopsy are also prescribed in certain cases. The differences between them are as follows:

TESA or testicular puncture with a needle consists of obtaining spermatozoa directly from the testicle by means of aspiration with a needle whilst under local anaesthetic.

It is not an invasive procedure and has a low complications rate.

There is also another type of procedure: direct introduction of the needle into the epididymis or microsurgical aspiration of sperm from the epididymis (Microsurgical Epididymal Sperm Aspiration: MESA). This procedure is not so common.

What is TESE or Micro-TESE?

Another technique for obtaining spermatozoa is through a testicular biopsy (TESE or Micro-TESE). This is surgery in which spermatozoa are obtained. It consists of opening up 2 to 3 cm of skin on the testicle in order to obtain tissue from the testicle and, at the same time, the sperm which may be stored within it. The material from the testicle is split up and used for reproduction techniques and for research purposes. Sometimes, in particularly extreme cases, the procedure is carried out several times (two or three times on each testicle in different areas). On the whole, the patient is sedated and there are different types of biopsies and techniques using a loupe or surgical microscope (Loupe, Micro-TESE). The aim in both cases is to obtain the most adequate material from the testes (spermatozoa) and which will lead to improved results in assisted reproduction treatment whilst limiting the damage as much as possible.

Whatever the technique, the specialist biologist studies the samples right from the moment at which they are obtained in real time so that they can be validated and so that the urologist may be asked for more or less material. The urologist’s role is also to provide the very best material (spermatozoa) whilst always taking into account that the testicle should be damaged as little as possible.

It is important to take into account that, in many cases, the material obtained by testicular puncture can be equally as good as the material obtained from a testicle biopsy. However, in a biopsy, the pain suffered, the damage to the testicle, the risks and the recovery can be different. It is also important to keep in mind that, sometimes, it’s necessary to go through these procedures more than once. The decision on if one technique is more suitable than another in order to obtain spermatozoa will always be taken by the urologist.

The advantage of testicular puncture in those cases in which this procedure is used, is that we obtain the necessary material and the testicle does not need to undergo any further damage. It is also less expensive. The quality of the material obtained ought not to vary depending on the technique used, but depending on what the patient’s testes provide. If the material obtained from the puncture is insufficient, based on an evaluation by a biologist, a biopsy may be carried out.

As can clearly be seen, one technique cannot be considered better than the other. Only careful selection in each case will return the very best material with spermatozoa for reproduction and cause the least possible damage to the testicle.

Dr Luís Prieto, Director of Urology at Instituto Bernabeu