Azoospermia is a medical condition where viable sperm is completely absent in the ejaculate. This can occur either due to abnormal sperm production (non-obstructive) or due to a physical obstruction. The condition affects approximately 1 per cent of the male population and accounts for roughly 5 to 10 per cent of all male infertility cases. While previously the only recourse in such cases was using donor sperm, recent advances have led to the development of methods including TESA (testicular sperm aspiration) and TESE (testicular sperm extraction), which allow to extract sperm directly from the testes. The retrieved sperm is then used for the purposes of IVF.
Testicular sperm aspiration is considered to be a fairly simple procedure, which takes approximately 10 minutes and is performed under local anesthesia. It is performed in cases of obstructive azoospermia and for patients who had undergone a vasectomy, and its timing is coordinated with the partner's/donor's egg retrieval date. During the procedure a needle is inserted into the testicle and sperm/tissue is aspirated.
The obtained material is then studied under magnification and the obtained sperm (if located) is then either prepared for an IVF procedure or frozen for future use. Often a single spermatozoon will be selected for the purposes of ICSI.
Occasionally, however, the amount of tissue/sperm obtained during TESA is insufficient. In such cases, testicular sperm extraction (also known as testicular biopsy) is required. The procedure involves the removal of a small fragment of testis tissue from which spermatozoa can later be extracted.
It is usually performed under local anesthesia using a small needle, although in certain cases a minor surgery, which involves a scrotal incision may be required. Like TESA, TESE is may be useful for patients suffering from obstructive azoospermia and patients who had undergone a vasectomy.