Since the improvement of microscopic sperm retrieval in 2014, the success rate of azoospermia testicular sperm retrieval has been stabilized at about 50%, and we have successfully retrieved sperm for a number of patients with testicular sperm failure and “in vitro” fertilization.
Since this technology was introduced late in Guangdong, many patients, medical staff, and even doctors engaged in male medicine and reproductive specialists are not aware of it, therefore, we will answer some of the questions frequently raised by outpatients.
1. We can find sperm for some patients with difficulty
Patients with significantly reduced testicular volume (testicular volume 2ml, about the size of a peanut)
Significantly elevated FSH on blood test (highest FSH 74 IU/L in a successful sperm retrieval case)
Previous external testicular biopsy did not find sperm (microsurgery improved the sperm acquisition rate by about 20%)
One extra chromosome, 47 XXY (success rate of microsemination does not decrease)
Patients waiting for sperm donation Artificial insemination or “test tube” (no delay in waiting for sperm donation)
testicular atrophy and azoospermia after mumps
Testicular atrophy and azoospermia after chemotherapy for tumors
No sperm found after juvenile or adult cryptorchid surgery
2. Frequently asked questions at the azoospermia clinic
Q: I have already had a testicular biopsy at an outside hospital and no sperm was found, is microsurgery still necessary?
A: For patients with severe testicular spermatogenesis disorders, microsurgery is more targeted than traditional incisional biopsy or puncture biopsy, and it is easy to find the small amount of spermatogenic tissue that exists locally.
Q: I have been to many hospitals, saying that the testicles are too small and the blood test indicators are too high to find the sperm
A: Due to the limitations of technical means, the traditional view was that sperm retrieval surgery was not recommended for those patients with severely underdeveloped testes and significantly elevated FSH because the success rate was too low; however, the development of microsurgery has broken through this barrier. The prestigious Cornell University in the United States summarized the results of their 1127 microseminal retrieval procedures in 2014 and found that even with testicular volumes as small as 2 ml (the size of a peanut rice), sperm was still retrieved in more than half of the patients; and abnormalities in blood FSH and inhibin B testing did not decrease the success rate of microseminal retrieval. From the results of our center’s surgery, the conclusion is consistent with them, and several patients with small testicular volume and blood FSH of 30 or more have found sperm.
Q: We have already done donor insemination, will the sperm retrieval procedure delay me from waiting in line for a donor “test tube”?
A: As long as patients have the desire to have their own offspring, they can make an appointment for sperm retrieval at our center and apply for sperm donation at the same time as they register for sperm retrieval. The waiting time for sperm donation is currently 3-6 months. Patients can make use of the waiting period to schedule the procedure, and if sperm is found, they can cancel the sperm donation directly and refund the fee, while patients who fail to find sperm will continue to wait for sperm donation and the waiting time will not be extended.
Q: Do I need anesthesia for microscopic sperm retrieval, what is the cost, length of stay and success rate of the procedure?
A: Microscopic sperm retrieval is routinely performed under local anesthesia for low cost and quick recovery, with inpatient examination on the first day, surgery on the second day, and discharge on the third day, and the ability to eat and get out of bed before and after surgery. The current success rate of surgical sperm retrieval is about 50%, depending on the etiology and condition of different patients, which will be explained in detail by the outpatient doctor according to the patient’s condition.
Q: Can the sperm be preserved after surgery and what should I do if my first “test tube” is not successful?
A: Microsurgery is mainly for patients with very poor testicular function, and the sperm obtained is even more precious. We will try to preserve the sperm by dividing it into 2-3 parts as much as possible, so that even if the first “test tube” is unsuccessful, there is still a chance to continue the pregnancy later. If the sperm is too small to be divided, we will explain this to the patient specifically. The sperm will be kept for half a year (enough for 2 in vitro fertilization treatments), but if you need to extend the storage period due to special circumstances, please apply.
Q: If I was born with an extra chromosome, 47 XXY, do I have no hope of finding sperm and even if I have offspring, it is not normal?
A: Even with 47 XXY, there is still a chance of finding sperm, and the probability of finding sperm is higher than those with unexplained azoospermia; such patients often have poor testicular development and abnormal blood hormone levels, but the probability of finding sperm does not decrease. According to the statistics of microscopic sperm retrieval cases all over the world, the success rate of sperm retrieval in 47 XXY patients is more than half; the probability of chromosomal abnormalities in the born offspring is less than 1%, and the safety of IVF is the same as that of other azoospermic patients.
Q: How can I arrange for surgical sperm retrieval if I have no sperm after chemotherapy?
A: First of all, it is recommended to go to a sperm bank to freeze the sperm before chemotherapy; if no sperm is found after chemotherapy, it is routinely recommended to stop using chemotherapy drugs and other drugs that may interfere with sperm production for six months before surgical sperm retrieval.
Q: Can surgical sperm retrieval be performed when one testicle has been removed, or when the testicle is hidden in the abdominal cavity or cannot be felt in the scrotum?
A: First of all, it is recommended that children receive surgery for cryptorchidism before the age of 2 to pull the testicles from the abdominal cavity to the scrotum; if the surgery is not performed in time at an early age, the surgery should also be performed as soon as possible after adulthood. For patients who have undergone testicular descent surgery and still have no sperm after the surgery, sperm retrieval surgery can be arranged, and the probability of finding sperm in such patients is over 60%; while for patients who have not undergone testicular descent surgery, the testicles should be pulled into the scrotum as soon as possible, and the semen should be rechecked for sperm 3-6 months after the surgery.