Needle Method in IVF Treatment

The needle method has become a popular term in IVF treatment. Sperm can be aspirated with a needle from the testicle or the vas deferens (a structure located right next to the testicle that contains the sperm). Some medications are given to calm the male candidate and some local anesthesia is used to numb the area. A small needle is then inserted and the sperm is aspirated from the epididymis or testicle. The procedure usually takes about 30 minutes.

Different sperm aspiration and extraction procedures have long names as well as short names (abbreviations):

PESA – Percutaneous Epididymal Sperm Aspiration (can be done in the office) TESA – Testicular Sperm Aspiration (can be done in the office) TESE – Testicular Sperm Extraction involves making a small incision and cutting away some tissue from inside the testicle.

The sperm must be of sufficient quantity and quality to be able to fertilize the female partner’s eggs in the laboratory, using a procedure that injects a single sperm into each egg. This procedure is called intracytoplasmic sperm injection, or ICSI. Once fertilization is complete, in vitro fertilization – IVF culture techniques are used to culture the resulting fertilized eggs for 3-5 days before embryo transfer to the woman’s uterus. Since multiple eggs are needed to have a good chance of success, the woman must undergo ovarian stimulation and then an egg retrieval procedure.

If eggs are retrieved on the same day, sperm can be used fresh, otherwise it can be frozen and thawed and used later. Usually enough sperm is aspirated so that it can be split into several vials and multiple attempts of IVF can be made, if necessary.

The sperm aspiration procedure is usually performed by a urologist who specializes in male fertility cases. In some cases, it may be performed by a reproductive endocrinologist (infertility specialist).

Success rates with PESA or TESA and IVF with ICSI

The success rate is very dependent on the IVF live birth success rates of the in vitro fertilization laboratory. IVF success rates also depend on the age of the female partner, even in these “male factor” cases after vasectomy. The female partner’s ovarian reserve, best measured by antral follicle count, is a good predictor of the chance for a successful IVF outcome.

intracytoplasmic sperm injection (ICSI) and in vitro fertilisation (IVF) now make it possible to extract a single sperm and use it directly to fertilise an egg. The latest surgical sperm retrieval techniques combined with ICSI and IVF mean that even men who produce almost no sperm can overcome infertility.

A low sperm count is a common cause of male infertility, but if a man produces even the smallest number of sperm in his semen, they can be collected fairly easily. Men who ejaculate no sperm due to blocked tubes in their testicles or a genetic condition that prevents their sperm from being released will require some form of surgical sperm retrieval so that intracytoplasmic sperm injection can be performed.

Surgical sperm retrieval methods – IVF needles

The main methods of surgical sperm retrieval available are:

PESA: percutaneous epididymal sperm aspiration. MESA: microsurgical epididymal sperm aspiration.TESA: testicular sperm aspiration. Includes testicular fine needle aspiration (TFNA). TEZ: testicular sperm extraction. Microinsight TESE.Perc biopsy: percutaneous biopsy of the testicles.

Necessary tests before surgical sperm retrieval

A man who does not produce sperm in his semen is suffering from azoospermia. This may be due to a blockage in one of the tubes that carry sperm from the testicles, causing it to leak out into the penis during ejaculation. Obstructive azoospermia may be caused by testicular cancer, as the tumor presses on the vas deferens. This type of cancer is common in young people and can be treated successfully. However, it can lead to infertility, so surgical sperm retrieval may be performed to store some sperm before starting treatment.

Other conditions cause non-obstructive azoospermia, including an abnormal cystic fibrosis gene. Men with this condition may not have all the symptoms, but most often they have no vas deferens. Surgical sperm retrieval is possible, but there is a 50:50 chance that subsequent embryos produced by ICSI and IVF will show the same genetic abnormality. Options then include using a sperm donor and intrauterine insemination (IVU) or IVF, or performing pre-implantation genetic diagnosis (PGD) to select embryos that carry the normal gene.