89264 Sperm identification from testis tissue, fresh or cryopreserved

Name of the Procedure:

Sperm Identification from Testis Tissue
(Common names: Testicular Sperm Extraction, TESE
Technical term: Sperm Identification from Fresh or Cryopreserved Testis Tissue)

Summary

Sperm identification from testis tissue involves extracting and examining tissue from the testes, either fresh or previously frozen (cryopreserved), to locate and retrieve viable sperm. This can be used in assisted reproductive techniques like in-vitro fertilization (IVF).

Purpose

This procedure helps men with certain types of infertility by locating viable sperm directly from the testicular tissue. The primary goal is to enable conception through assisted reproductive technologies for those who have low or no sperm in their ejaculate due to various medical conditions.

Indications

• Azoospermia (absence of sperm in the ejaculate)
• Blockages due to vasectomy or congenital issues
• Testicular failure of unknown cause
• Difficulty retrieving sperm through less invasive methods

Preparation

• Pre-procedure consultations and examinations by a urologist or reproductive specialist
• Blood tests for hormone levels and general health check
• Instructions to avoid blood-thinning medications, alcohol, and smoking before the procedure
• Fasting may be required if general anesthesia is used

Procedure Description

1. The procedure begins with the patient placed under local or general anesthesia.
2. A small incision is made in the scrotum.
3. A biopsy needle or scalpel is used to remove small samples of testicular tissue.
4. The tissue is then examined under a microscope to identify the presence of viable sperm.
5. If viable sperm are found, they can be used immediately for IVF or cryopreserved for future use.

Duration

The procedure typically lasts between 30 to 60 minutes.

Setting

This procedure is performed in a hospital or an outpatient surgical center with appropriate facilities for reproductive services.

Personnel

• Urologist or Reproductive Specialist
• Surgical Nurse or Technician
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Pain and discomfort in the scrotal area post-procedure
• Infection at the biopsy site
• Bleeding or hematoma formation
• Potential for tissue damage, though rare
• Anesthesia-related risks

Benefits

• Provides an opportunity for men with azoospermia to father biological children
• Can be critical for successful in-vitro fertilization (IVF)
• Relatively short and minimally invasive procedure

Recovery

• Ice packs and pain medications for discomfort
• Restricted physical activities, especially avoiding heavy lifting and strenuous exercise for a few days
• Wearing supportive underwear to minimize discomfort and swelling
• Follow-up appointments to monitor recovery and discuss results

Alternatives

• Sperm aspiration from the epididymis (PESA or MESA)
• Donor sperm for in-vitro fertilization
• Adoption or child-free living Pros and cons vary: some alternatives may be less invasive but may also involve different ethical or personal considerations.

Patient Experience

During the procedure, patients under local anesthesia may feel pressure but no significant pain. Under general anesthesia, the patient will be unconscious. Post-procedure, there may be mild to moderate discomfort managed with over-the-counter pain relief and supportive measures. Most patients can resume routine activities within a week, following medical advice and follow-up consultations.