Testicular biopsy and TESA
No sperm cells in the semen sample
If there are no sperm cells in the semen sample (azoospermi) on examination at either the local hospital or here at the clinic, this may be due to a lack of formation of sperm cells in the testicle or an occlusion of the vas deferens i.e. the sperm cannot be ejaculated.
The inability to produce sperm cells in the testicle may be the result of a congenital defect in the testicular tissue, whilst the lack of sperm cells in the semen may be due to blocking of the vas deferens, for example caused by a Chlamydia infection.
An examination can be made as to whether there are living sperm cells in the testicular tissue by taking a small sample from the testicle (testicular biopsy). Provided that this testicular biopsy reveals that sperm cells are present, the same procedure can be performed later in connection with IVF treatment of the woman, whereby micro insemination (ICSI) can be used to fertilise the eggs with the man’s sperm cells (see description in the next section under TESA).
If there are no sperm cells present in a testis biopsy, donor insemination can be carried out (see patient information concerning insemination with donor sperm).
The procedure, which is quite painless, is performed here at the clinic and takes around half an hour. The couple will get an answer to the examination immediately after the procedure. A local anaesthetic is applied to the groin and on the scrotum, after which sterile washing is carried out whilst the local anaesthetic takes effect. Pain-relieving medicine (Morphine) is offered and given intravenously via a hypodermic needle located in the hand. After around 5 minutes, a sample is taken from the testicle by means of a thin needle. The majority of men experience very little discomfort in connection with the procedure. In the laboratory at the clinic the extracted biopsy is examined for the presence of sperm cells.
After the procedure
There may be mild pain in the scrotum and groin for a few days after the procedure, and therefore you’re advised to take it easy for a few days. The man may go to work, as long as this doesn’t involve hard physical labour. Pain-relieving tablets in the form of Panodil can be taken as needed, although max. 2 tablets 4 times daily is recommended.
In the event of more severe pain, swelling, reddening or fever, contact Fertility Clinic IVF-SYD or your GP/doctor on duty. This is extremely rare, however.
In men who’ve previously been sterilised or men in whom the above testis biopsy has revealed sperm cells in the testicle, it’s possible to extract sperm cells from the testicle (TESA, testicular sperm aspiration) in conjunction with IVF treatment. These sperm cells can be isolated and used to fertilise the woman’s egg after egg retrieval.
After sterilisation, there’ll usually be sperm cells present, even if sterilisation was carried out many years earlier.
Extraction of sperm from the testicle in connection with IVF treatment
TESA is carried out on the same day – and preferably shortly before – the woman undergoes egg retrieval. TESA is carried out precisely as described above in the section on testicular biopsy. Only a few sperm cells are extracted in connection with a TESA, as it’s only necessary to extract the same number of sperm cells as there are eggs. Since there are only a few sperm cells, the woman’s eggs are always fertilised by means of micro insemination, called ICSI (Intra Cellular Sperm Injection). When carrying out ICSI, the sperm cell is injected into the egg under the microscope by means of a thin glass needle.
In very rare cases, there may not be any living sperm cells found in connection with the above procedure, even though previous tests have shown the presence of sperm cells. Prior to egg retrieval, you should therefore have discussed whether – should this situation arise – the extracted eggs should be fertilised with donor sperm, be destroyed or frozen as unfertilised eggs.