Infertility in Men - Treatment

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Percutaneous Epididymal Sperm Aspiration. Percutaneous epididymal sperm aspiration (PESA) uses a needle to obtain mature sperm from areas in the upper parts of the epididymis (the coiled tube where sperm are stored before ejaculation). It is performed under local anesthesia, sometimes in the doctor's office, is less expensive than other techniques, and recovery is fairly painless. However, it has less of a chance of achieving sufficient sperm than MESA, and there is also a chance of hitting a blood vessel, causing bleeding.

Testicular Sperm Extraction. Testicular sperm extraction (TESE) is a microsurgery that removes a small amount of tissue from one or more areas of the testes using incisions and microsurgery techniques. The tissue is placed in a culture and chopped into tiny pieces, and the sperm are extracted. It is a complex process, however, and may cause more pain than other sperm retrieval procedures.

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Testicular Sperm Aspiration. Testicular sperm aspiration (TESA) uses a needle-like biopsy device to draw a small sample of testicular tissue. Multiple attempts are sometimes required to retrieve sperm.

Sperm Washing

Methods for washing sperm can help improve the ability of sperm to move towards the egg. Sperm washing can also help remove sexually transmitted viruses, such as HIV and hepatitis, that could potentially be transmitted to the woman during fertility treatment. The simplest method involves:

• The sperm is mixed with a nutrient-rich fluid (or culture media) in a test tube.
• They are then centrifuged (spun very rapidly) for about 5 minutes.
• The sperm, which are heavy, settle on the bottom, forming a dense button of millions of pure sperm. The fluid left on top is siphoned off.
• This procedure may be repeated.

Swim-Up Technique

The swim-up technique is not only a useful diagnostic procedure for testing the ability of sperm to escape from the semen into the cervical mucus, but it also achieves the goal of removing sperm from semen.

• A specially prepared semen sample is placed in a tube.
• A culture media (a nutrient-rich substance in which cells thrive) is placed on top of the sample.
• The medium is a hospitable environment for sperm, and those that are healthy will swim up to it.
• After an hour or more, the culture is examined, and the number of sperm that have reached the medium is compared to the number still remaining in the semen.