Microsurgical Sperm Extraction

Vasectomy reversals are not an option for men who do not have sperm present in their ejaculate (referred to as obstructive azoospermia). This problem occurs because of a blockage in the male reproductive tract, an absent vas deferens (tubes that deliver sperm to the testes) or epididymal obstruction. For some men, sperm production may be normal in the testicle but the sperm are trapped inside the epididymis.

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Diagnosis

Following irregular semen analysis, you’ve been diagnosed with infertility, your TUCC physician will first discuss potential behavioral changes that could improve your chances of conceiving. This could include having sex more often to build up a better concentration of sperm. Retrograde ejaculation can often be treated with over-the-counter cold medicine. If abnormal hormone levels are detected following a semen analysis, you may also be a candidate for hormonal replacement therapy.

voiding dysfunction

Microsurgical Sperm Extraction

At the Center for Men’s Health at TUCC, we utilize two techniques for sperm retrieval: Microsurgical Epididymis Sperm Aspiration (MESA) and Testicular Sperm Extraction (TESE). Microsurgical sperm extraction offers surgeons additional dexterity in extracting limited areas of sperm. Lasting about an hour, our team performs microsurgical sperm extractions in a dedicated OR suite at the Urology Surgery Center of Colorado. Recovery time lasts just a few days and complications are rare.

MESA is typically performed in men with vasal or epididymal obstructions. During the procedure an incision is made in the scrotal skin and the testis and epididymis are exposed. Using an operating microscope, a single epididymal tubule will be opened to extract the sperm. MESA allows surgeons to retrieve large numbers of sperm that may be frozen and used in future fertility cycles. This eliminates the need for future procedures and limits the amount of epididymal damage. Many men undergoing sperm extraction may also be candidates for a reconstructive epididymovasostomy (connection of the vas deferens and epididymis to bypass a blockage). The combination of the sperm extraction and surgical procedure increases the likelihood of sperm appearing in the ejaculate.

TESE is similar to MESA, but only involves the testis (testicle). First, your TUCC physician will expose the testis with a small incision. This allows for the sperm to be assessed immediately. For men with very limited sperm production, only microscopic areas of mature sperm may be present in the testis. To find these areas, a careful dissection is performed using an operating microscope before any sperm are extracted.

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Resources & Events

The Transurethral Suprapubic endo-Cystostomy (T-SPcC): A Novel Suprapubic Catheter Insertion Device

TUCC physician Lawrence Karsh, M.D., served as a lead investigator in this clinical trial which investigated the first human experience with the Transurethral Suprapubic endo-Cystostomy (T-SPeC®) device, a novel disposable device used for introducing a suprapubic catheter via a retrourethral (inside-to-out) approach similar to the Lowsley technique. The results of this investigation were published in

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