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Outpatient Procedures > Sperm Aspiration and ISCI


In cases of reproductive tract obstruction such as prior vasectomy or trauma, there are no sperm in the ejaculate, but spermatozoa are continuously produced within the testicle. These sperm may be removed from the epididymis or testis and then used for IVF/ICSI. In these cases, the female partner is stimulated for ovulation induction. When her eggs are removed by ultrasound guidance, a single sperm is microinjected into each egg for fertilization. The developing embryos are replaced into the uterus with delivered baby rates ranging between 20-27% per cycle.

These techniques may also be used for men with non-obstructive condition. These men have an underproduction of sperm with only limited numbers within the entire testicle. The sperm are insufficient to fill all of the tubular structures and, as a result, no sperm reach the ejaculate. Nevertheless, some sperm may be retrieved from the testes and then used for IVF/ICSI.

Dr. Marmar has developed new techniques that do not require open surgery conducted in an operating room (J Androl. 19:517,1998). Using percutaneous methods, Dr. Marmar performs sperm acquisition procedures in an office setting and the patient receives just a single injection of local anesthetic to the spermatic cord. The sperm are extracted by needles (percutaneous methods)instead of open incisions.

Sperm Aspiration Fig. 1
Percutaneous aspiration of epididymis with butterfly needle. Droplets are specimen.
Sperm Aspiration Fig. 2
Percutaneous aspiration of testis with 18 guage
angiocatheter. Seminiferous tubules appear in tubing.
Sperm Aspiration Fig. 3
Seminiferous tubules are processed and excess tissue is cryopreserved.

Data suggests that percutaneous procedures performed in the office have a low level of complications. The birth rate for one cycle was 27%. If the patients persist through four cycles then the birth rate can reach 52% (J. Urol. 163 suppl.:303,2000). These new procedures offer options and hope for some men who were previously considered untreatable.

Recently, Dr. Marmar introduced a technique that utilizes ultrasonic guidance for even the most difficult cases.

Extracted sperm from these percutaneous procedures can be frozen in liquid nitrogen. The shipping canisters can be sent anywhere in the world. Dr. Marmar has co-managed cases with local urologists and reproductive endocrinologists to ensure continuity of care and treatment success. Patients from local communities, other states and foreign countries have utilized these services.

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