Recently male fertility has been getting a lot of attention because it has now been approved for government subsidies. It is said that 1 in 10 men are concerned with male fertility.
The first thing to do in a male infertility test is to check the condition of the sperm.
Amongst the abnormalities of sperm that lead to male infertility we can divide them into big groups: few sperm “oligozoospermia”, sperm with slow movement “asthenospermia”, sperm with many malformations “malformation spermatidosis”, and no sperm “azoospermia”.
This time we have asked Dr. Yoshihiro Tada, a male fertility specialist in regards to “TESE”, which is the treatment method used for azoospermia.
Graduate from Kyoto Prefectural Medical University, after working at the National Maizuru Hospital, Kyoto Prefectural Yosanoumi Hospital, and Matsushita Memorial Hospital he then joined Oak Medical Group at Sumiyoshi.
He has extensive experience in hysteroscope surgery. Presently, he is in charge of a wide range of practices from Urology, testicular extraction of sperm (TESE) to hormone treatment, specializing in male infertility.
Azoospermia is when males have no sperm within the semen.
1 out of 20 men concerned with infertility have azoospermia. It can be divided into 2 main groups, those with obstructive azoospermia that is caused by a blockage in the vas deferens which carries the sperm, and those without obstructions but is no ability to produce sperm or it is severely weakened.
By a hormone test and the size of the testes we will know if it is non-obstructive or obstructive.
The surgery where a scalpel is used to make an incision in the scrotum and then to directly collect sperm from the testicular tissue is called “TESE (testicular sperm extraction)”.
The surgical method will vary slightly depending on the place of the problem. “Conventional TESE” will be used in cases of obstructed azoospermia, that has a problem in the vas deferens which carries the sperm, and “MD-TESE” will be used in cases of non-obstructed azoospermia, that has a problem in the testes.
Conventional TESE will use a scalpel cut into the scrotum, 3~5mm in length cuts will be made in 2~3 places on the testicle, and sperm will be collected from the seminiferous tubule in that section.
Sperm can be harvested from any seminiferous tubule based on the premise that sperm exists there.
On the other hand, for males with non-obstructed azoospermia with problems in the testes, it is extremely limited to the section that sperm is made, it is not understood where the sperm is. So for MD-TESE, the scalpel is used to cut into the scrotum and the testicle largely cut open, and by using a magnifying glass a search for a suitable seminiferous tubule appearing to have sperm will be searched out and then the sperm will be collected.
At Oak Clinic, TESE is being performed in the clinic alongside a urology specialist.
If it is a clinic that cannot do TESE on site, then you will have to go to an urologist, do TESE and have the sperm frozen.
When the sperm is needed for microinsemination, the frozen sperm will need to be brought in and then thawed, but the quality of the sperm will have decreased if you go about it in this way.
At Oak Clinic, in order to fertilize the oocytes with fresh sperm, we are performing TESE in sync with the oocyte pick up (OPU), that way we can minimize sperm loss.
If on the day of TESE sperm cannot be collected, we will freeze the oocytes so that the OPU will not have been wasted.
In cases when sperm cannot be collected even in “MD-TESE”, then we use the next method. First of all we will check to see whether or not there are any sperm cells by pathological examination.
When there are sperm cells, if the sperm cells are stimulated, then there is a possibility that the sperm can be collected.
In that case, the sperm collection rate of the 2nd “TESE” will be at less than 10%, but for about half a year you can take injections of pituitary hormone to stimulate the sperm cells and once again you can have the “TESE” surgery.
Additionally, in the case of having no sperm cells, we are only seeing testicular tissue of one portion where sperm is likely to be with “TESE”.
By chance it was only that there might have not been sperm nor sperm cells there. Therefore, there is also a method of searching for sperm in another location on the 2nd time and after.
It is a 1-day procedure and the surgery time is about 30 minutes for those with obstructive type, and around 1 hour for those with non-obstructive type.
There will be no pain as it is done under a general anesthesia. Please feel comfort in knowing that we will prescribe pain killers after the procedure.
The cost is about ¥250,000, and when it is done at the same time as the OPU it will be about ¥600,000.
In the case of male infertility, there are no subjective symptoms and you probably won’t come in for an examination. The female starts fertility treatment and somewhere down the line it is mostly discovered when the male is tested. If you are a male and have the slightest of a doubt, then please come in for a consultation.