absence of spermatozoa: microsurgical retrieval

Treatment recommended for patients who have azoospermia (absence of spermatozoa in the ejaculate) and wish to have children. These cases can have obstructive causes (epididymis retrieval is performed) or of non obstructive causes (testicle retrieval is performed).

These techniques associated with assisted reproduction procedures have allowed these men to genetically produce their own children.

Some techniques can be used:

• PESA:
  (Percutaneous Epididymal Sperm Aspiration )
  Technique offered to patients with obstructive azoospermia. A small needle is passed directly into the head of the epididymis through the scrotal skin and fluid is aspirated
• MESA:
  (Microsurgical Epididymal Sperm Aspiration)
  This technique is offered to patients with obstructive azoospermia. It involves dissection of the epididymis under the operating microscope and identification of seminiferous tubules then sperm is aspirated.
• TESA:
  (Testicular Sperm Aspiration)
  Technique offered to patients who present nonobstructive or obstructive azoospermia when previous techniques have failed. It may also be used in patients who have a sperm DNA fragmentation rate greater than 30%. It involves percutaneous puncture of the testis with a needle where fragments of the testis are aspirated, from where the spermatozoids will be removed. If necessary it can be performed in the contralateral testicle in the same procedure.
• TESE:
  (Testicular Sperm Extraction)
  It is a technique that follows the same recommendations of TESA. However, it is used in more difficult cases of non obstructive azoospermia. Performed through a small scrotal incision, exposure of the testis and epididymis, testicle fragments are retrieved, without magnification image, and this material is sent to the laboratory for the extraction of spermatozoa. It can be performed on a contralateral testicle, in the same procedure, if necessary.
• Micro-TESE:
  Currently, this is the technique that we use most in patients with non-obstructive azoospermia and in those who did not obtain sperm in the TESA, and the micro-TESE, also more efficient than TESE. Using the surgical microscope and microsurgery material, we perform the microdissection of the seminiferous tubules of the testis, looking for areas where there is a greater chance of finding sperm, scanning the entire testicular parenchyma and greatly increasing our chances of success in obtaining sperm , as well as decreasing the chance of complications of these procedures when compared to non-microsurgical techniques.