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Male Infertility

Male infertility is caused by a variety of factors that include structural abnormalities, hormonal disturbances, genetic defects and medical conditions that can be life threatening. Lifestyle choices and environmental exposures can also be contributors.

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Sperm Retrieval

Sperm is formed and developed in the testicles. They are transported to a network of tubules called the epididymis where they continue to mature and gain the ability to move more effectively. Then, they are transported to the vas deferens (the area that is cut during a vasectomy) and finally, during ejaculation, the sperm are rapidly propelled to the prostate and ejected out the penis.

There are a variety of techniques that Dr. Gittens utilizes to retrieve sperm for in-vitro fertilization (IVF). He will discuss with you the approach that is right for your situation. 

Percutaneous Aspiration of Sperm

Percutaneous retrieval of sperm is done with a fine needle. This can be done in the office with only local anesthetic. Percutaneous aspiration is most successful in patients that may have an obstruction, but otherwise normal sperm production.

Microscopic Epididymal Sperm Aspiration

Another form of retrieving sperm is called microscopic epididymal sperm aspiration or MESA. During the MESA, sperm is directly taken from a single isolated epididymal tubule under a surgical operating room microscope. After 10-20 million sperm are obtained, the epididymal tubule is closed with multiple microscopic sutures. The procedure avoids the blind passage of a retrieval needle into the epididymis and testicle. The procedure can be performed in advance of in-vitro so the couple can be assured the male has adequate sperm production.

Testicular Sperm Extraction and Microscopic Testicular Dissection

Azoospermia is a condition where there is no sperm seen on the semen analysis. This can be caused by a variety of reasons. Regardless of the cause, Dr. Gittens may perform either a testicular sperm extraction (TESE) or microscopic dissection of the testicles. The TESE is performed by making a small incision into the testicle and removing a piece of testicular tissue to be used for in-vitro fertilization.

The microscopic testicular dissection is performed when the TESE is unsuccessful in identifying sperm. The testicle is carefully opened and with an operating room microscope, the testicle is meticulously scanned and sampled for areas of sperm production in the tissue. These areas are then retrieved and used for IVF. For the best results, a microscopically trained urologist that specifically treats male fertility should perform this procedure.

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