Testicular Sperm Aspiration (TESA) in South Africa

The sperm aspiration procedure is usually performed by a specialist (urologist) that specialize in cases of male fertility. In some cases, it can be done by a reproductive endocrinologist who has is a doctor with a specialty in infertility.

If the sperm is obtained on the same day as the eggs it can be used fresh. I not it can be frozen and used later. However, it has to be thawed before use. Usually, the sperm aspirated is enough for multiple attempts of IVF.

Sperm retrieved from the seminiferous tubules in a TESA procedure are usually less mature and less motile than sperm which are found in ejaculated semen. Therefore, intracytoplasmic sperm injection (ICSI) a special form of IVF is used to achieve fertilization with TESA sperm. It involves injecting a single sperm into each egg.

• A TESA treatment cycle involves a woman going through a stimulated IVF cycle whereby the ovaries are stimulated to produce multiple eggs.
• In the testicular sperm aspiration procedure, a very fine needle is passed into the testicles. The patient is usually under local anesthesia. A tiny amount of material is removed from the network of tiny tubes where sperm are produced (seminiferous tubules). The seminiferous tubules are then processed in the laboratory, where they are checked for the presence of sperm, which can be either used to fertilize eggs or frozen for future use. If the sperm sample was previously frozen, it is thawed and prepared on the day the egg is collected.
• Doppler ultrasonography is sometimes used during testicular sperm aspiration. It guides the aspiration to increase accuracy, avoid blood vessels and reduce hematoma formation.

The doctor will perform tests which will help to predict if the sperm can be obtained at the biopsy. Tests are also important because they show the presence of any conditions that could cause problems in children born from the procedure. The tests performed include:

• Hormone tests: Follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone levels are measured. Abnormally high FSH and LH and low testosterone are an indication that the testicles are not functioning properly. They also indicate that chances of obtaining sperm are low.
• Physical examination: If the testicles are very small, it means the chance of obtaining sperm are low. In addition, conditions such as congenital absence of the vas deferens can be identified through physical examination.
• Chromosome analysis: Chromosomal abnormalities may make producing sperm for some men impossible. Although it may not cause other problems other than sperm production, it can cause problems for the children born.
• Cystic Fibrosis testing: Cystic fibrosis is common in men who have absent vas deferens. If the gene is present, then it increases the chances of the child being affected. If the man but not the woman carries the gene, the treatment can continue.
• HIV and Hepatitis: All individuals storing eggs, sperms or embryos are screened for HIV and hepatitis B and C. These rules out any chance of cross contamination in the embryo storage vessels and in the laboratory.

The female partner will also undergo tests to check the womb and hormonal tests to ensure she can produce eggs.