Infertility can be experienced by a large number of couples, with male infertility being responsible for close to fifty percent of all infertility. Thankfully, the development of assisted reproductive technologies (ART) have provided parents a much needed additional option. One such advancement is Testicular Sperm Aspiration (TESA), a simple technique to harvest sperm from the testicles.
One frequently asked question is, Can TESA be combined with IVF or ICSI? The simple answer is Yes. More often than not, In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI), are paired with TESA when men experience significant challenges to becoming a biological parent due to lack of or difficulties with sperm production and/or ejaculation.
This article discusses the combination of TESA with IVF, ICSI, other assisted reproductive technologies, and sperm retrieval, along with the candidates for their use, procedure, success rates, risks involved, and what to anticipate at different stages of the fertility process.
What Is TESA?
Testicular Sperm Aspiration (TESA) is a procedure used to harvest sperm from the testicles through the use of a small needle by a fertility specialist. This procedure is conducted under local anesthesia and is more favourable than other surgical techniques to retrieve sperm.
TESA is typically used for males with little or absent sperm present in the ejaculate due to a number of conditions, including:
– Obstructive azoospermia
– Non-obstructive azoospermia in selected cases
– Vasectomy or failed vasectomy reversal
– Absence of the vas deferens
– Disorders of ejaculation
– Severe male factor infertility
The retrieved sperm are used either immediately or stored for future procedures.
Understanding IVF and ICSI
Before explaining where TESA fits into the picture, the differences between IVF and ICSI must be understood.
In Vitro Fertilization (IVF)
IVF is the process whereby a woman is stimulated to produce multiple eggs, the eggs are then removed and fertilized by sperm in a lab, and the resulting embryos are transferred into the woman’s uterus.
The traditional IVF process requires a sufficient quantity of healthy and motile sperm to naturally assist in the fertilization of the egg in the lab.
Intracytoplasmic Sperm Injection (ICSI)
ICSI is a specialized type of IVF where, instead of fertilization occurring in a lab, a healthy sperm is directly injected into an egg by an embryologist using specialized microscopic equipment.
Because TESA generally results in a limited number of sperm that may or may not be motile, **ICSI is the usual option of choice** when using TESA sperm.
Can TESA Be Combined with IVF or ICSI?
Yes, TESA in conjunction with IVF or ICSI is one of the treatment options for severe male infertility with a high success rate.
Sperm collected by TESA can be:
– Used right away in an IVF or ICSI cycle,
– Frozen for later use in other fertility treatments, or
– Used in several IVF or ICSI cycles if enough sperm are collected.
Even though IVF may be an option, ICSI is the preferred option as it gives better fertilization rates in the case of the sperm being operatively retrieved because only one sperm is required to fertilize each egg.
Consequently, most fertility experts suggest utilizing TESA with ICSI over traditional IVF.
How Does The Combined Procedure Work?
Typically, the treatment consists of a series of consecutive, coordinated steps:
1. Female Fertility Assessment
The female partner undergoes a fertility assessment consisting of hormone testing, ultrasound imaging, and an evaluation of the ovarian reserve.
2. Ovarian Stimulation
The ovaries are stimulated with hormonal medications to facilitate maturation of multiple oocytes.
3. Egg Retrieval
Mature oocytes are collected via a minimally invasive procedure performed under sedation.
4. TESA Procedure
Either on the same day, or on a preceding day if sperm are cryopreserved, the fertility specialist performs TESA to collect sperm directly from the testis.
5. Laboratory Preparation
The fertility laboratory staff examines the sperm and testicular tissue for the presence of healthy sperm.
6. ICSI Fertilization
Sperm and oocytes undergo fertilization via the technique of intracytoplasmic sperm injection (ICSI).
7. Embryo Development
The fertilization of oocytes is monitored on a daily basis and the subsequent embryonic development is assessed.
8. Embryo Transfer
The healthy embryos are transferred to the uterus with the remaining viable embryos cryopreserved.
Why ICSI with TESA?
Sperm obtained from TESA may be different from the sperm obtained from a normal semen sample, with differences that may include:
– Lower number of sperm.
– Lower motility.
– May require selection with assisted techniques.
ICSI overcomes these difficulties as the embryologist directly injects the selected sperm into the oocyte.
In addition, the limited sperm sample is better utilized, with increased likelihood of successful embryo development and higher fertilization rates.
– the need for active sperm movement is greatly reduced
– the combination of TESA and ICSI is one of the best options for addressing severe male infertility.
Who is the Perfect Candidate for TESA with IVF or ICSI?
This treatment combination is suitable for men with:
– Obstructive Azoospermia
sperm is produced but remains blocked and does not enter the semen.
– A Previous Vasectomy
TESA can be an option for couples to conceive, when a vasectomy cannot be reversed.
– Congenital Abnormalities of the Reproductive Tract
some males are born with no Vas deferens, and/or have other anomalies that result in an absence of sperm in the semen.
– Ejaculatory Dysfunction
some men may not be able to ejaculate due to certain neurological disorders or injuries, although sperm production may be normal.
– Severe Male Factor Infertility
men with extremely low sperm counts and/or failed ejaculation sperm retrieval
What Are the Chances of TESA Combined with ICSI Being Successful?
The chances of this combination treatment being successful depends on a number of factors.
– the age of the female partner,
– quality of eggs,
– quality of embryos,
– cause of male infertility,
– knowledge of laboratory technicians,
– experience of the fertility clinic.
As a rule of thumb:
– sperm retrieval is very successful in men with obstructive azoospermia.
– the rate of fertilization in ICSI is very similar to that of IVF with ejaculated sperm.
– the rate of pregnancy is dependent on the quality of the embryo and the female, and is not dependent on how the sperm was retrieved.
Each case is unique, and therefore requires a thorough consultation.
What Are the Advantages of TESA, Combined with IVF, or ICSI?
this combination treatment provides many advantages to the patients:
– Very Little Invasion
TESA requires only a fine needle, and generally only local anesthesia is needed.
Biological Parenthood
Men without sperm in their ejaculates are still able to have genetically related children.
High Fertilization Potential
ICSI has an excellent chance of successful fertilization with very little sperm.
Sperm Freezing Option
Sperm that is surgically retrieved can be frozen for later IVF or ICSI cycles.
Short Recovery
Many men are able to resume their normal daily activities in one to two days.
Are There Any Risks?
TESA is a safe procedure, but like any procedure, there is a certain level of risk.
Some of the potential problems are:
– Mild pain/discomfort
– Swelling
– Bruising
– Bleeding
– Infection (rare)
– Not having viable sperm retrieved (some cases)
Your fertility specialist will go over these risks with you and will decide what type of sperm retrieval is best for your condition.
Preparing for TESA with IVF or ICSI
The preparation can include, but is not limited to:
– Thorough fertility assessments
– Hormone testing
– Semen testing
– Genetic testing if needed
– Blood work
– Smoking cessation
– Reduced alcohol use
– Maintaining a healthy weight
– Reduced stress
Answering your physician’s questions can improve your treatment options.
Emotional Considerations for Couples
All fertility treatments can be taxing emotionally on both partners. TESA combined with IVF or ICSI can mean many simultaneous procedures and much waiting.
Many couples find the following helpful:
– Counselling
– Emotional support groups
– Communication with healthcare providers
– Realistic expectations on the likelihood of success with the treatment. Emotional health is an important aspect of the fertility journey. It should be addressed.
Conclusion
For couples experiencing extreme male infertility, TESA in combination with IVF or ICSI provides a successful route to pregnancy. When sperm is absent from the ejaculate, ICSI is used to give greater control over the process of fertilization by injecting a single sperm into each egg.
An improved outcome for treatment is likely with this combination of therapies, taking into consideration the cause of infertility and the fertility of the female partner.
If you or your partner has been diagnosed with azoospermia or a serious male infertility condition, a knowledgeable fertility expert can help evaluate whether TESA combined with IVF or ICSI is appropriate for your case.
Frequently Asked Questions (FAQ)
Most men report only mild discomfort during and after TESA, which is usually performed under local anesthesia.
Sperm obtained by TESA can be frozen, and will be used successfully in later IVF or ICSI treatment cycles.
Usually, since the quantity and quality of sperm obtained by the TESA method is very limited, the combination of IVF and ICSI will be used, instead of natural conception.
Donor sperm, alternative sperm retrieval procedures, or other treatment options may be recommended by your fertility specialist based on your condition.
