MICROTESE AND ICSI WITH “FRESH” SPERM
A procedure of absolute excellence that only a few Assisted Reproduction Centers can guarantee is the MICROTESE AND ICSI WITH “FRESH” SPERM.
RATIONALE: Usually a patient with Non-Obstructive Azoospermia is submitted to MicroTESE in order to retrieve sperm from the testicular tissue thanks to the technique presently considered the “gold standard” inasmuch offering the highest success rate (approximately 58% in our most recent series on patients with testicles never undergone surgical sperm retrieval earlier). In case of positive recovery, sperm are frozen after being divided into various vials. When the oocyte retrieval for ICSI is performed, one or more vials will be thawed and the biologists will select the normal-shaped sperm (remained viable after the freeze-thaw procedure) and inject them into the oocytes (ICSI). For some couples this procedure presents a risk depending on two factors: 1) the ability of spermatozoa to tolerate the freezing-thawing procedure is individual and unpredictable, therefore for some subjects only very few spermatozoa will be found alive and usable for ICSI after thawing; 2) if the sperm recovery resulted "weak" during MIcroTESE (that is, due to the extent of the testicular damage, only a few spermatozoa had been recovered), after thawing only a poor number of spermatozoa will be usable for oocyte fertilization, maybe allowing only a single ICSI cycle.
THE SOLUTION: These risks can be avoided by performing the ICSI with “fresh” sperm. That is, the woman is prepared to perform the recovery of oocytes for the ICSI and in the same morning the male partner undergoes a Microtese. In this case the retrieved sperm are partly used immediately for injecting the oocytes, and the exceeding ones are frozen for any subsequent ICSI cycles, if necessary. This procedure has the obvious advantage that even in the case of "weak" recovery, that is, of only a few spermatozoa, they will be enough to perform the ICSI cycle. Not only: many clinical experiences suggest that using fresh sperm offers slightly higher fertilization rates, and therefore ongoing pregnancy rate than by frozen-thawed spermatozoa.
The possible risk inherent in MicroTESE with “fresh” sperm ICSI is the unsuccessful sperm retrieval from testicular tissue. In this case for the couple there are two possibilities: 1) to cryopreserve the oocytes, in view of a later use according to their own decisions; 2) to allow the Center to use donor’s sperm, if the consent to this procedure was previously pre-signed by the couple’s two members (donor’s sperm come from selected and sanitary guaranteed healthy subjects). Referring to this last point: a) our Center guarantees to always carry out at best, according to the State of the Art, the sperm retrieval procedure with Microtese; b) in the case of an agreed recourse to donor’s sperm, the couple has a fine chance for solving their infertility once and finally, avoiding further emotional tensions, travel expenses and other wasted time.
N.B .: The reason why the MicroTESE with “fresh” sperm ICSI is rarely offered in the Assisted Reproduction Centers is due to the higher organization costs for the Center (not for the couple!, because they have no cost surcharge). In fact, in the MicroTESE with “fresh” sperm ICSI the whole team of andrologists - anesthetists - biologists – operative room nurses has to remain available every day for a whole week, while the optimal day of egg pick-up is decided (day depending on the not always well predictable response of the woman to ovarian stimulation).