What are the Indications for Testicular Biopsy in Infertile Men ???
Quality of man’s sperm is second ultimatum in IVF success, first being quality of woman’s eggs.
Male factor infertility is not given due focus in test-tube baby centers in Delhi. Lifecare IVF Centre , runs a dedicated clinic for male infertility/Andrology. It is important to share that 40% of our IVF centre’s cases in last one year were due to male factor only.
In our experience, when the male partner has a concentration of motile sperms of less than 10 million per ml, fertilization ability following conventional IVF ( Non ICSI ) begins to decline as sperm’s fertilizing potential is linked to concentration of motile sperms.
The combination of clinical evaluation and testicular biopsy for male infertility is becoming progressively more important because new technologies allow men previously considered infertile to father children. It is important to remember that testicular biopsy need to be done only in Tertiary Infertility Care Units ( IVF Centers ).
Evaluation of severely oligospermic ( less than 5 millions/ml ) or azoospermic ( No sperms in ejaculate ) male may include either open or percutaneous testicular biopsy to determine whether viable sperms are present in seminiferous tubules. It is so satisfying to see that even men with Testicular Failure diagnosed by elevated serum FSH levels with marginal testicular size may have adequate sperm on biopsy for use in ICSI. The biopsy specimen can be cryopreserved for future use of sperm during an IVF – ICSI cycle. However , freshly biopsied specimens are generally felt to provide higher success rates. Thus the biopsy may have diagnostic, prognostic and therapeutic value.
In the vast majority of patients Obstructive Azoospermia may be distinguished clinically by size of testis and serum FSH levels from Non Obstructive Azoospermia. Patients with non obstructive azoospermia are best treated with therapeutic testicular biopsy and sperm extraction, with processing and cryopreservation for usage in IVF and ICSI. Diagnostic biopsy has no value in this group.
Lifecare IVF Center is equipped with sperm retrieval biopsy expertise ( PESA, MESA, TESA/TESE etc ) and sperm freezing.
Testicular Sperm Extraction (TESE) or Testicular Sperm Aspiration (TESA)
TESE/TESA enables men with sperm duct blockage due to trauma, inflammation, a previous vasectomy, or azoospermia (no sperm in the ejaculate due to poor testicular sperm production) to father a child
through IVF almost as if there were no obstruction to sperm passage at all. The procedures have rendered surgical reconstructive anestomosis in Obstructive azoospermia and surgical vasectomy reversal in men with long-standing vasectomies (10 years or more) totally unnecessary.
TESE/TESA are both simple, low-cost, safe, and relatively pain-free. Most men can literally take off a few hours for the procedure and return to normal activity soon thereafter.
TESE involves the introduction of a needle through the skin of the scrotum directly into the testicle(s), a 15- to 30-minute procedure usually under local anesthesia. Hair-thin specimens of testicular tissue are
removed, sperm is extracted from the tissue, and a single sperm is injected into each egg using ICSI.
TESA involves direct aspiration of sperm via the needle inserted into a sperm duct.
Following successful TESE/TESA the fertilization rate is 70 percent when ICSI is performed in centers of excellence. The IVF birthrate per TESE procedure performed on women under 40 in these centers is better than 40 percent (i.e., no different than conventional IVF birthrates in women of comparable age). When TESE is performed on men with azoospermia, pregnancy rates are halved.
Microsurgical Epididymal Aspiration (MESA)
MESA involves making an incision in the scrotum and exposing the small sperm-collecting ducts on the surface of the testicles. Sperm is aspirated through a needle inserted into these ducts. The method is much more traumatic and invasive than are either TESE or TESA and only has a place in cases where it is intended to collect enough sperm to perform IVF/ICI with some sperm left over for freezing. We do it under general anesthesia.
Good counseling and explaining what is wrong and what will be done is very important and relieves lot of stress of patient.
Thanks for lot of greetings from our old patients and well
wishers
on Doctor’s Day…….
Dr. Sharda Jain
M.D. (PGIMER), MNAMS, FiCOG FIMSA,DHM,QM & AHO
Consultant : Reproductive Medicine
Programme : Director : Lifecare IVF
Dr Abhishek Singh Parihar
MBBS ,MS , Fellow. Reproductive Medicine
Consultant – Reproductive Medicine
Lifecare Institute of Infertility & IVF.
