Tag Archive for: What is ICSI Treatment

What is Surgical Sperm Retrieval

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Infertility has become a common problem among couples worldwide, various factors contribute to the difficulties in conceiving. Factors such as male infertility including low sperm count, obstructive or non-obstructive azoospermia, or retrograde ejaculation contribute to the same. Our medical science provides hope by directly collecting sperm from the male reproductive tract, a specialised process called surgical sperm retrieval.

In this blog, you will get all the information about this procedure, different techniques of the procedure, when it is needed etc

What is Surgical Sperm Retrieval

When a man has azoospermia, a condition in which he has little or no sperm in his ejaculate.

A medical procedure called surgical sperm retrieval is used to directly obtain sperm from a man’s reproductive tract. It is beneficial for couples who struggle with male fertility to achieve pregnancy through assisted reproductive technologies (ART) like in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

Such conditions become a hurdle in achieving pregnancy where a man faces difficulties in the production of sperm. Urologists or IVF experts perform the procedure of extracting sperm from the male reproductive system.

When is surgical sperm retrieval necessary?

Surgical sperm retrieval is a process of extracting sperm from a man’s reproductive system in the case of low or no sperm production, which leads to issues in pregnancy and becomes very challenging for couples. In several scenarios, it becomes necessary to go for surgical sperm retrieval where natural conception is hindered due to male infertility issues.

Following are the main indications for when to visit the IVF centre for a surgical sperm retrieval procedure.

1. Obstructive Azoospermia

This condition is called when there is a blockage in the male reproductive system and is causing issues in sperm production with the semen. Due to these blockages, the sperm is unable to pass by.

It can occur through the congenital absence of the tube that carries sperm from the testicles to the urethra.

2. Non-obstructive Azoospermia

In such conditions, the amount of sperm produced is very low or no sperm is produced through the testicles of a man. It occurs due to genetic factors, testicular damage caused due to trauma or chemotherapy or due to hormonal imbalances.

You can go through infertility treatment including Testicular Sperm Extraction (TESE) to retrieve sperm directly from the testicular tissue.

3. Retrograde ejaculation

A condition in which semen enters the bladder and is not expelled through the urethra during ejaculation. Such is the scenario with people suffering from neurological conditions, previous surgeries if any or diabetic patients.

You need to visit the best fertility doctor to get the right treatment in such a case.

Techniques used in Surgical Sperm Retrieval.

Techniques used for Surgical Sperm Retrieval

There is a set of techniques, that have indications, considerations, and advantages based on the cause of male infertility. The choice of technique depends on the condition of a person and careful evaluation by the best fertility specialist.

Here are the Primary Techniques used in Surgical Sperm Retrieval:

1. Percutaneous Epididymal Sperm Aspiration (PESA)

This method involves sucking out sperm from the epididymis from a fine needle attached to a syringe. This technique is used for patients having obstructive azoospermia, where there is a blockage in the epididymis preventing sperm from reaching the semen.

It is a process that can be easily performed under local anaesthesia in an outpatient setting.

2. Testicular Sperm Aspiration (TESA)

A procedure when sperm production is impaired or absent within the epididymis or when epididymal sperm retrieval is not feasible. This technique involves a needle that extracts sperm directly from the testicle. It can be performed under local anaesthesia and is less invasive than other techniques.

3. Microsurgical Epididymal Sperm Aspiration (MESA)

It is a technique useful in cases in which the number of sperm needed is high or in the case where previous attempts with PESA were unsuccessful. High powered surgical microscope is used in performing such a technique, a small incision in the scrotum is made to directly visualize the epididymis. The fertilization specialist then identifies the sperm and extracts it from the epididymal tubules.

In this technique, there is less chance of damage to surrounding tissues and it also allows precise identification and retrieval of sperm.

4.  Testicular Sperm Extraction (TESE)

TESE is used in the cases of patients having non-obstructive azoospermia, a condition that includes impaired or low sperm production within the testicles. It is a feasible technique that involves retrieval of sperm directly from the testicular tissue, by removing a small piece of testicular tissue through a minor surgical procedure and then is sent to the laboratory to examine the areas containing sperm.

5. Microdissection TESE (Micro-TESE)

Such a technique is perfect for cases of severe non-obstructive azoospermia, where there are extreme impairments in sperm production. It is performed under higher magnification as it is a specialized form of TESE. The goal of this technique is to lower the trauma to the testicular tissue and increase the retrieval of sperm.

RISKS INVOLVED!

Risks involved in such IVF procedures are minimised when performed in top fertility clinics. And is generally a safe and effective procedure performed under the proper supervision of the experts.

However, there can be risks involved like any other surgical procedure.

The following are the factors that should be considered before proceeding with the procedure:

  1. Infection
  2. Bleeding
  3. Discomfort and pain
  4. Damage to surrounding tissues
  5. Anaesthetic risks

FREQUENTLY ASKED QUESTIONS!

1. Is surgical sperm retrieval painful?

It is relatively a less painful procedure involving a fine syringe being inserted in the epididymis or the testicle to extract the sperm performed under local anaesthesia.

2. How successful is surgical sperm retrieval?

In patients with obstructive azoospermia, there is a very high chance of recovering sperm by this method (>90%). Whereas in patients with non-obstructive, the chances are 40%.

3. What is the difference between TESA and TESE?

TESA= no incision or surgery required in TESA, only the needle is inserted under local anaesthesia with very low pain, low time and low charges. Whereas in TESE, biopsy surgery is done to extract tissue under General anaesthesia.

4. What are the side effects of PESA and TESA?

Side effects of PESA and TESA include mild swelling or bruising at the site of the procedure which usually resolves within a few days.

5. What are the signs of low sperm count?

Decreased facial or body hair, inability to impregnate women, pain or swelling in the testicle area, and difficulty maintaining an erection can be the symptoms of low sperm count.

Why Choose Us?

Choosing our clinic Imprimis IVF for surgical sperm retrieval will turn out to be the best decision when it comes to your reproductive health because we ensure compassionate care with a team of highly experienced professionals. We are equipped with advanced technologies to tailor to your unique fertility needs and provide treatment accordingly.

We understand this emotional challenge and hence provide a supportive environment and transparent communication to help you gain the trust and confidence in choosing us. Our clinic provides expert care and personalised attention throughout your journey to parenthood.  We have a track record of successful procedures, providing reassurance and support at every step.

How ICSI can help with infertility

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How ICSI can help with infertility – It is a common misconception that infertility means IVF. We need to understand that infertility is a very broad topic. Moreover, the reason behind infertility is not common for everyone. The root cause and other factors, like the couple’s medical history, help decide the best fertility treatment.

In this article, let us explore which couples can take the help of ICSI and fulfil their dream of getting pregnant.

What is ICSI?

ICSI stands for Intracytoplasmic Sperm Injection. It is an Assisted Reproductive Technology that is immensely helpful in treating severe male infertility, abnormal semen, and ejaculation issues. In ICSI, a single healthy sperm is injected directly into the egg to increase the chances of conception.

Can ICSI be recommended to everyone? 

No. ICSI is recommended in certain cases only. A thorough medical examination of the male and the female is done to determine the root cause of infertility. ICSI is the best option when:

  • The sperm count is very low to perform IVF or IUI.
  • Antisperm antibodies are present in high concentrations in the semen.
  • The sperm cell is abnormally shaped, has low motility, or has no acrosome (an organelle that contains fertilisation enzymes and is in the front end of the sperm head).
  • The male has a vasectomy or a blockage in the reproductive tract that disrupts the production of sperm cells or prevents them from coming out during ejaculation.
  • Low-quality frozen sperm is used during treatment.
  • Preimplantation genetic diagnosis (PGD) is used.
  • The doctors are unable to detect the root cause of infertility.
  • There is some difficulty in fertilising the egg during IVF.
  • The couple has had multiple IVF failures.

What is the Process of ICSI?

ICSI comprises several steps, which are stated as follows: 

1. Ovarian Stimulation–

The first and foremost step in ICSI is stimulating the ovaries. Several injectable medications are given to the woman for about 10 to 12 days to stimulate the production of more mature eggs.

These ICSI injectable medications consist of Luteinising hormone (LH) and follicle-stimulating hormone (FSH). During the stimulation phase, the woman is asked to pay a visit to the clinic regularly for administration of medications, blood tests, and monitoring of the egg development process by the ovaries.

With medical advancements, self-administered ICSI injections are also available. The doctors will guide you properly about how to use them at home. Your fertility clinic will also provide videos and handwritten notes for the same.

After the ovaries produce enough eggs, a trigger injection is administered to the woman. The hCG trigger injection–human chorionic gonadotropin or buserelin, helps the eggs’ maturation. The embryologist closely monitors this process, and the egg retrieval process is carried out before ovulation based on the status of the egg’s health.

2. Egg Retrieval-

The egg retrieval process occurs after 10-12 days of ovarian stimulation. A thin needle under ultrasound monitoring is used for retrieval. This needle makes its way into each ovary to remove the egg-containing fluid. These eggs are carefully examined by the gynaecologist and then placed in a petri dish containing culture media. The whole egg retrieval process is done under anaesthesia and takes about 20 to 25 minutes.

 3. Sperm Retrieval-

The sperm from the male partner is thoroughly washed and prepared in the laboratory. The healthiest sperm cell for ICSI is chosen based on its motility, normal head shape, and overall appearance to increase the chances of fertilisation.

The sperm cell is retrieved either naturally or using surgical procedures stated as follows: 

  1. Testicular Sperm Aspiration (TESA)
  2. Percutaneous Epididymal Sperm Aspiration (PESA)
  3. Testicular Sperm Extraction (TESE)
  4. Micro Epididymal Sperm Aspiration (MESA)
  5. Microdissection TESE (microTESE)

4. Administering the Intracytoplasmic Sperm Injection-

A single healthy sperm cell is chosen and picked with the help of a thin glass needle. A highly skilled and experienced embryologist will inject a healthy sperm directly into the egg for fertilisation. This process is done with a special medical instrument called a Micromanipulator and an inverted microscope, which offers high magnification.

 5. Embryo Development-

After some days, tiny embryos are formed and carefully monitored for 4-5 days. Depending on the health, the embryo can be transferred from day 2 to day five. On the 5th day, the embryos will enter the blastocyst stage. The blastocyst embryos are preferred in ICSI because they have a high implantation rate and are more mature than Day 3 embryos. In some rare cases, day six embryos are transferred to the uterus.

6. Embryo Transfer–

If the embryo/s is healthy, it is transferred to the uterine cavity for implantation. Generally, one or three of the healthiest embryos are transferred by fertility experts. This process takes about 5-7 minutes and is undertaken without anaesthesia. The embryos with a small amount of fluid are loaded in a catheter inserted in the woman’s uterus. This fluid will help release the embryos into the uterine lining. The embryologist closely monitors the whole process with an external abdominal ultrasound.

General Instructions for a Successful Embryo Transfer 

A good clinic like Imprimis IVF will give you proper instructions to prepare yourself, like consuming liquids 30-40 minutes before reaching the clinic.

It would help if you arrived with a full bladder as it helps to track the uterus lining for proper placement of the embryo/s. The embryologist will inform you about the development and the number of embryos that should be transferred to increase the chances of conception.

How long does it take to confirm pregnancy after ICSI? 

The pregnancy test after ICSI should be done two weeks after the embryo transfer.

Male Infertility that can be treated with ICSI 

ICSI is witnessed to be the best treatment option to address male infertility. The following medical conditions related to male infertility can be successfully treated with ICSI:

  • Oligospermia– A condition where the sperm count in the ejaculation is below 15 million per millilitre of semen. A male has a normal sperm count when the semen sample contains more than 15 million sperm/ml. 
  • Azoospermia– A condition in which no sperm cells are found in the semen.
  • Teratozoospermia– A situation in which the semen sample contains abnormally shaped sperm cells that cannot swim through the uterus to reach the egg to fertilise it.
  • Asthenospermia– A situation in which the semen contains slow-moving or less motile sperm.
  • Anitsperm Antibodies- As the name suggests, these antibodies treat sperm cells as foreign particles and kill them.

The minimum sperm count for ICSI is 4 million sperm/ml of semen. 

Benefits of ICSI Treatment

  • ICSI offers a high fertilisation rate of approximately 80%.
  • ICSI is one of the best Assisted Reproductive Technologies to tackle male infertility.
  • ICSI can help couples with multiple IVF failures.

How much does ICSI Treatment Cost? 

The cost of Intracytoplasmic Sperm Injection in India depends on the seriousness of the infertility issue, medications, geographic location, success rate of the clinic, and the expertise of the embryologists and gynaecologists. On average, the treatment cost of ICSI lies somewhere between INR 90,000 to 2,50,000. 

How Successful is ICSI the first time? 

ICSI offers a high fertilisation rate of 80-85% when the treatment is done by a highly experienced fertility specialist using the best practices.

Is ICSI better than IVF? 

Both ICSI and IVF have a similar success rate. ICSI is the best option in case of severe male infertility, whereas IVF is recommended for female infertility with poor egg quality. It completely depends on the root cause of the infertility, personal needs, and medical conditions of the couple.

Final Word about How ICSI can help with Infertility

ICSI is also a wonderful option to treat male infertility. The chances of success increase when you choose the right fertility clinic, like Imprimis IVF, Srinagar. Why? This treatment demands close examination using the latest medical tools and personal attention that only an experienced IVF specialist can offer. ICSI can be what you seek, so consult a trusted gynaecologist. That’s all about How ICSI can help with infertility problems.