Many IVF doctors are now advising their patients to do a surgical sperm retrieval ( either a PESA – percutaneous epididymal sperm aspiration) or a TESE ( testicular sperm extraction) for doing their IVF/ ICSI treatment. Now this may sound like a mouthful, so let me share some more information to put it in context.
One of the commonest reasons for doing ICSI is couples with male-factor infertility . These are typically men with a low sperm count , or poor sperm motility , who are not good candidates for simpler procedures such as IU and IVF because their sperms are not capable of fertilizing their wife’s eggs . This is why doctors advise them to do ICSI, which is the right advice.
Now the problem arises when there is poor fertilization in the ICSI laboratory with these ejaculated sperm. The commonest reason for the poor fertilization is usually a bad laboratory, because the technician is clumsy or the embryologist doesn’t know how to do the ICSI procedure well. But when they get bad quality embryos, the embryologist refuses to take any responsibility . And because the IVF doctor knows nothing at all about what happens in the IVF laboratory , the clinic is happy to blame the poor sperm quality for the poor quality embryos. Now this makes a lot of intuitive sense, even to the patient. After all, if they are poor quality sperm and sperm are responsible for fertilizing the egg, then it makes a lot of sense that it is the poor sperm quality that is responsible for the poor quality of the embryos , and therefore they need to look for an alternative. And for patients who refuse to use donor sperm, the doctor then advises surgical sperm retrieval. These doctors claim that the reason for the poor quality fertilization rates after the ICSI cycle was the fact that the sperm were collected from the semen, which means the sperm were exposed to a lot of unhealthy toxic influences in the semen , which damaged their fertilizing ability. They suggest that the best way to prevent this toxic damage is to retrieve fresh sperm directly from the testis , and use these for doing ICSI . This procedure is called a TESA ICSI. These “toxic influences” are all imaginary, but the poor patient is completely confused and doesn’t know any better . He often goes to a second or third clinic for another opinion , where the doctor often orders a sperm DNA fragmentation test to assess sperm quality. Now this test is also a load of rubbish , but patients will do it because they know no better . And when the results are reported as being abnormal , the doctor says – we have proof that the reason for the poor quality of your embryos was your poor quality sperm , as evidenced by the high sperm DNA fragmentation and therefore it does make sense to use testicular sperm ! But you need to do it at our clinic , and not at the earlier clinic, because we’re much better ! And some patients will go to a male infertility specialist ( aka andrologist ) to get more information , and he will provide exactly the same advice , because he can make more money by doing a testicular biopsy , and he’s very happy to offer his services.
Now even after doing a testicular sperm aspiration and ICSI< they still end up getting poor quality embryos ! This is because the problem was never with the sperm in the first place – it was with the laboratory , and a bad laboratory will produce bad embryos , whether you use testicular sperm or ejaculated sperm ! Now, to add insult to injury, they tell the patient to use donor sperm !
Please remember that surgical sperm retrieval should only be used for men with azoospermia (zero sperm count ). If there are sperm in the semen – even if there’s just one sperm per high power field and even if your count is as low as 0.0001 million per ml, good embryologists will use sperm from the semen, because these sperms are more mature , and the fertilization rates with ejaculated sperms are actually better than with testicular sperm . A good laboratory will be able to collect enough sperms for doing ICSI – often by asking you to provide a sequential ejaculate . Remember that most embryologists are not capable of handling testicular sperm well at all , because this is technically much more challenging, but they hide this fact from patients, by refusing to share photos of embryos !
If an IVF doctor advises you to do a surgical sperm retrieval when you do have sperm in your semen, please run away from that clinic as fast as you can.
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