MALE INFERTILITY AND SPERM HARVESTING.
Sperm and testosterone production are the two main function of the testes, they both go and on hand in order for fertility
to take place. Although its rare for a man during reproductive age to have abnormalities of testosterone or testicular production
of sperm, they occur from time to time.
INFERTILITY
Approximately 15% of all couples are infertile. Up to fifty percent of these infertile
couples will have a male factor component and 30% of couples will not be able to conceive solely because of a male factor.
AZOOSPERMIA, which means zero sperm is one of the abnormalities we encounter from time to time and the
role of the Urologist is to determine if there is a congenital absence of the ductal system (e.g. vas deferens) or any other
portion thereof that could be present bilaterally. If the problem is only in one side it could go unnoticed since fertility
is usually not affected.
DUCTAL OBSTRUCTION: This is not an uncommon problem. We usually see it on patients who had a vasectomy
in the past, their marital status changes and they remarry or wish to father another child, an attempt for reversal of the
vasectomy (vaso-vasostomy) fails and the next option is to retrieve the sperm from the epididymis or the testes itself.
A team approach with the Embryologist, usually a Phd in infertility who works very closely with the Infertility Gynecologist
is essential for this retrieval to be successful. Sperm retrieval now days can take place at any time and extemporaneous as
to when the female partner is ovulating , since the sperm is nourished, prepared and retrieved for placement at the ideal
time.
SPERM HARVESTING: AT UROLOGY CONSULTANTS we engage in a diligent approach of collaboration with the Infertility
team so the retrieval, preservation and prompt recovery of the donor sperm and male partner, goes seamlessly.
We understand and appreciate the cost considerations to the male sperm retrieval and have established relationships with
outpatient surgical centers, anesthesiologists and our own office team to keep the cost to a minimum and at the same time
offer top notch quality services.
We believe in improving fertility rates for our race and country so generations to come can carry the task that our forefathers
did for us in America. So please, do not confuse our reasonable and fair prices with a lesser quality of outcome and results.
You results will be almost perfect from a technical point of view and we are “in your corner” to see your child come to this
earth. Many factors play a role in infertility success rates, we keep the sperm harvesting at a minimal risk and strive for
successful part of this equation.
THERE ARE SEVERAL TYPES OF
PROCEDURES FOR HARVESTING SPERM
Sperm Retrieval Procedures
TESA/TESE/Micro TESE/MESA/PESA
Explanation of Procedures
There are a variety of different procedures available to retrieve sperm for
planned IVF/ICSI.
Testicular sperm aspiration (TESA)
Testicular sperm aspiration (TESA) is a procedure performed for
men who are having sperm retrieved for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). It is done with
local anesthesia in the operating room or office and is coordinated with their female partner’s egg retrieval. A needle is
inserted in the testicle and tissue/sperm are aspirated. TESA is performed for men with obstructive azoospermia (s/p vasectomy).
Often TESA doesn’t provide enough tissue/sperm and an open testis biopsy is needed.
Percutaneous Epididymal Sperm Aspiration (PESA) PESA is a procedure performed for men who are having sperm
retrieved for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) who have obstructive azoospermia from either
a prior vasectomy or infection. It is done with local anesthesia in the operating room or office and is coordinated with their
female partner’s egg retrieval.
Testicular sperm extraction (TESE)/Testis biopsy/Testis mapping
TESE/testis biopsy/testis mapping are
procedures performed for men who have testis failure. The procedure is performed to see if there are sperm present as well
as for pathologic diagnosis to evaluate for malignancy. It is either done as a scheduled procedure or is coordinated with
their female partner’s egg retrieval. TESE is usually performed in the operating room with sedation, but can be performed
in the office with local anesthesia alone.. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI.
This diagnostic biopsy is usually performed to evaluate for an obstructive etiology – microdissection TESE has replaced this
as the optimal form of retrieval for testis failure patients.
Microepididymal Sperm Aspiration (MESA) MESA is a procedure performed for men who have vasal or epididymal
obstruction (s/p vasectomy, cystic fibrosis). It is either done as a scheduled procedure or is coordinated with their female
partner’s egg retrieval. MESA is performed in the operating room with general anesthesia under the operating microscope. Patients
usually cryopreserve sperm during this procedure for future IVF/ICSI.
Microdissection TESE (microdissection testicular sperm extraction) Microscopic TESE is a procedure performed
for men who have testis failure. Microdissection TESE is performed in the operating room with general anesthesia under the
operating microscope. Patients cryopreserve sperm during this procedure for future IVF/ICSI.
Post-Operative Instructions
Please review the instructions below to assist in your recovery from your
scrotal surgery - these are general guidelines
-
Place an ice pack (a bag of frozen peas works well) inside underwear on top of gauze dressing – change every few hours
until bedtime the day of the procedure. Personally, I am not too fond of scrotal supports, the straps are tight on the groin
to the point of creating abrasions on the skind surface, unlike as its name implies, they provide little support to the testes.
I prefer a tight pair of jockey shorts, they are much more comfortable and they will hold the gauze in place.
-
Keep the gauze and fluff dressing in place for one day.
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Relax and rest for one to two days following your procedure. Avoid excessive walking, sitting for prolonged periods of
time, and unnecessary exertion. You will recover quicker and easier if you take it easy for these days immediately post-op.
-
Avoid exercise (no running, heavy lifting, straining, etc.) for one to two weeks. Avoid straddle activities like cycling,
horseback riding for at least two weeks.
-
It is expected to have a small amount of blood stain the gauze dressing. Sometimes the incision has a special type of “glue”
used in plastic surgery procedures (Dermabond®) its not unusual to find remanents of this glue around the incision. The purpose
of the glue is to minimize the number of sutures placed on the skin and create a barrier and prevent bacteria and sweat from
entering the incision. This is important during the first 72 hours. The glue peels off by itself with showering and time.
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You may take the narcotic medication as prescribed for discomfort or you may take over-the-counter motrin or advil as directed.
Do not take any aspirin products for two weeks following the procedure.
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You may shower tomorrow– pat your scrotum dry, do not rub. Do not take a bath or go swimming for two weeks.
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The incisions were closed with an absorbent suture. This suture dissolves on its own and does not need to be removed
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Abstain from intercourse for at least one week or until discomfort resolves, whichever is longer.
SPERM HARVESTING FOR FERTILITY PURPOSES
Prices as of January 1, 2011
We only work with Gynecology /Infertility/Endocrinologist and Embryologist who together comprise a team of specialist to
facilitate pregnancy.
PRICES---GLOBAL PRICE, ALL INCLUDED.
SPERM HARVESTING FOR INFERTILITY.
What is it?
The procedure for sperm retrieval via SURGERY at a surgery center.
Who sends the patient?
The infertility Gyn doctor----taking care of the spouse/partner.
Who is the patient?
Usually husband who had a vasectomy, reversal of a vasectomy (vaso-vasostomy) that
failed or duct obstruction.
Which insurance covers it?
NONE, even if the patient thinks they do, we do not check for coverage and
only get prepaid for these services.
PRICES: GLOBAL PRICE, ALL INCLUDED
(as of 1/1/2011) SUBJECT TO CHANGE.
First visit office visit: $125.00 (needed for history taking and examination) OF WHICH 25.00 IS REFUNDABLE
IF PATIENT GOES THROUGH WITH THE PROCEDURE.
PROCEDURE:
SURGEON: $725.00 (minus 25.00 refundable) from office visit.
ANESTHESIA:
$375.00
OUTPATIENT SURGERY CENTER: $475.95
TOTAL: $1,675.95
EMBRYOLOGIST: He will bill directly via infertility doctor.
When is the sperm inseminated?
Up to Gyn and Embryologist, usually the female partner will have to
be “prepped” with fertility drugs so she can produce many eggs at ovulation prior to insemination.
Please note that the Embryologist is present at the time of the sperm harvesting to preserve the sperm and he/she takes
the specimen with him for further nourishment and insemination.
Any questions, please call us. 407.332.0777 | 800.776.8643
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