Non-surgical sperm aspiration (NSA), is a simple, pain-free medical procedure that allows the doctors at Poma Fertility to quickly and easily obtain sperm for use in IVF procedures. NSA is often most used with men who cannot ejaculate or in men who have no sperm in their semen due to vasectomy or blocked ducts. Men who can ejaculate, but lack sperm in their ejaculate frequently have at least some sperm in their testicles. By using non-surgical sperm aspiration this sperm can be harvested to achieve pregnancy.
Non-surgical sperm aspiration is quick procedure, and is performed right at our center. The process does not require hospitalization, is painless when done under sedation, and recovery is virtually immediate. A tiny needle is used to extract sperm directly from the testis or the epididymis (part of the ducts just outside of the testicle).
Men who lack sperm in their ejaculate frequently have at least some sperm in their testicles, where sperm are made. Testicular sperm can fertilize eggs if they are injected directly into eggs obtained for in vitro fertilization (IVF) through a process called intracytoplasmic sperm injection (ICSI). While the ejaculate normally contains 100 to 300 million sperm, aspiration of as few as 100 to 200 sperm by NSA has been shown to be enough to achieve pregnancy.
Before the development of NSA, men with no sperm in their ejaculate had to undergo surgery to remove sperm either from their testes or from the tubes connected to the testes (vas deferens or epididymis). The operation required a hospital stay and lengthy recuperation.
The technique has been immensely helpful to men who have had vasectomies and later decide that they want to have children – perhaps because they have remarried. Reversing a vasectomy by having bypass surgery is possible, but the operation is frequently not successful, especially for men with longstanding vasectomies. Additionally, sperm quality after vasectomy reversal is often reduced and ICSI is required even if sperm appear in the ejaculate. For many men, non-surgical sperm aspiration eliminates the need for a vasectomy reversal surgery.
NSA will also help infertile men who lack sperm in their semen because the route out of the testes has been blocked by prior infection or congenital lack of development, as well as men who have had their prostates removed and can no longer ejaculate but do make sperm. Men who cannot ejaculate due to spinal cord injuries or neurological conditions like multiple sclerosis can also become fathers through the NSA technique.
The procedure has been performed on awake men, and under the right circumstances, the technique is tolerable. A few of the men believed that they had a very high pain tolerance and they refused sedation – almost all of these self-selected men did well without sedation. Occasionally circumstances will not allow time for safe sedation, but, even those without sedation do well. However, sedation is the preferred method.
Alcohol is used on the skin to prepare the testis. A small needle is inserted into the testis and then using suction with the syringe, essentially removing a small sample of tubules that contain sperm. The testicular tubules and fluid are placed into a small amount of culture media and the specimen is delivered to the embryology team.
The andrology staff then tease the tubules apart and mince them to release the sperm in to the media. We also have a sperm motility enhancing fluid that helps stimulate the sperm. Then a sample of the fluid is scanned for motile sperm. If the embryologist can find about 5-10 motile sperm using high power magnification then the procedure is done and the patient is removed from sedation.
Occasionally, there may not be sufficient sperm for the number of eggs. If the number of sperm retrieved is relatively low, rather than put the man through a second sedation, the procedure is repeated on the other testis before waking up the patient.
Sperm undergo a maturation process as they travel from the testicle through the epididymis and then the vas deferens, seminiferous tubules and urethra. Because the sperm aspirated from the testis has not functionally matured, it will not fertilize an egg without assistance. Intracytoplasmic sperm injection-ICSI is then used to get the sperm into the egg.
- Previous vasectomy (obstructive azoospermia)
- Low success rate expected with surgical reversal either because the vasectomy occurred many years ago or the female partner is older
- The couple prefers IVF treatments to a surgical vasectomy reversal
- “Emergency Aspiration” – the man cannot produce a specimen on the day of egg retrieval. Whenever sperm collection may be an issue, a sample is frozen in advance of the IVF treatment as a back-up. Sometimes the man simply does not anticipate having difficulty with collection.
- Non-obstructive azoospermia
- The male reproductive tract is not blocked but the sperm do not come out
- Usually if the testicles are producing sperm, the number of sperm is low and they are found in small pockets throughout the testicle.
- Testicular aspiration is much less reliable and an open testicular biopsy is usually recommended by a urological surgeon to identify the testicular tissue with sperm that can then be frozen
- Necrospermia (extremely poor quality sperm with mostly non-viable or non-motile sperm)
- The sperm in this situation is very poor and sometimes we can obtain more healthy sperm from the testicle
- This is an unusual indication but an important option for some men.