The ICSI (Intra Cytoplasmic Sperm Injection) through testicular biopsy TESA (Testicular Sperm Aspiration) is an In-Vitro Fertilisation procedure that uses an intracytoplasmic sperm injection with spermatozoa obtained directly from the testicle.
Some male patients do not produce spermatozoa in their ejaculate. This is known as Azoospermia. Nevertheless, depending on the cause of this azoospermia, in many cases a testicular biopsy is performed to extract spermatozoa from the testicle; this is an outpatient surgical procedure in which one or several incisions are made in one or both testicles to retrieve male spermatozoa and obtain a small sample. This sample is processed in the lab and if there are any spermatozoa we are able to obtain these.
The sample can be used either fresh or frozen.
Who is it recommended for?
The ICSI with TESA (Testicular Sperm Aspiration) helps patients overcome infertility problems such as:
- Obstructive azoospermia (e.g. after a vasectomy)
- Secretory azoospermia
- Severe male factor infertility
Is there any difference in the results obtained if I use a fresh or a frozen sample?
Using frozen sperm from the testicle yields the same results as using fresh sperm. Here is why: after retrieving the spermatozoa from the testicles, these are mixed with a freezing medium that contains a cryoprotector which protects the sperm during the freezing process and allows them to survive it.
Once we have the sperm (either fresh from the Biopsy or frozen) we can then proceed to inject the egg. For this procedure the biologist must find and select the best spermatozoon for fertilisation.
1. Extracting Testicular Sperm
This is a simple outpatient surgical procedure that is performed on patients under anaesthesia. To begin, a small incision is made in the scrotum and then another is made in the wall of one of the testicles allowing for a small amount of testicular pulp to be extracted. This sample is immediately processed to verify the possible presence of spermatozoa suitable for reproductive use. A testicular biopsy to obtain sperm can be performed before the In-Vitro Fertilisation treatment with ICSI or on the same day that the eggs are retrieved.
2. Sperm Freezing:
After retrieving the spermatozoa from the testicles, these are mixed with a freezing medium that contains a cryoprotector which protects the sperm during the freezing process and allows them to survive it. The mixture is then cooled to -196ºC and stored in tanks of liquid nitrogen until it is to be used.
3. Induced Ovulation (controlled ovarian stimulation)
This process involves administering medication to stimulate ovarian activity and obtain the highest possible number of eggs.
4. Follicular Puncture
Eggs are retrieved from the ovaries just before ovulation. The patient is sedated during the procedure which lasts approximately 15 minutes.
5. Thawing and Culture of Testicular Sperm
After thawing, the initial sample is evaluated and immediately processed. These types of samples generally need an average of 2 hours before motility can be observed, although this varies depending on the type of azoospermia.