Severe male factor infertility often precludes treatment with intrauterine insemination (IUI). When greatly decreased sperm count (severe oligospermia) is diagnosed in the ejaculate, intracytoplasmic sperm injection (ICSI) is required to achieve fertilization in the laboratory. However, when no sperm is identified in the ejaculate (azoospermia), alternative methods other than ejaculation must be employed in order to harvest sperm for use with ICSI. The type of sperm extraction procedure used depends on the etiology for azoospermia. In males with obstructive azoospermia, secondary to an absence or obstruction of the ejaculatory ducts (i.e. congenital bilateral absence of the vas deferens, vasectomy...), percutaneous epididymal sperm aspiration (PESA) or microsurgical epididymal sperm aspiration (MESA) may be used to isolate sperm directly from the epididymis (collecting tubule adjacent to each testis) for use with ICSI. When non-obstructive azoospermia is diagnosed (diminished sperm production within the testes), a testicular sperm extraction (TESE) may be performed. With TESE small fragments of testicular tissue are removed and sperm are isolated by careful dissection for use with ICSI. Sperm extraction procedures are usually performed on the day of egg retrieval in order to obtain fresh sperm for fertilization with ICSI. If enough sperm is obtained, some sperm may be frozen for later use so that additional extraction procedures may be avoided. All sperm extraction procedures are performed by a urologist, usually under local anesthesia.
The California Center for Reproductive Health employs the services of highly-qualified, board certified urologists who perform all sperm extraction procedures with utmost care directly on our premises.