Procedures and surgery to collect sperm in the treatment of male infertility

The article was written by Doctor Nguyen Ba Hung - Doctor of Orthopedics, Reproductive Support Center - Vinmec Times City International General Hospital.

Sperm collection surgery is performed for cases of azoospermia, i.e. no sperm can be found in the semen after at least 2 ejaculations at least 4 weeks apart. This case is sterile.

These are cases where sperm is still produced but due to blocked spermatic ducts, sperm cannot be ejaculated. The seminal vesicles start from the seminiferous tubules, which is also the place where sperm are produced, from these tubes sperm are pushed into the rete testis from the spermatic reticulum to be pushed to the efferent ducts. to enter the epididymis, at the epididymis, the sperms are trained to perfect their motility, and the sperm continue to be guided into the vas deferens, the seminal vesicles (these are the two main stores of sperm), When there is sexual stimulation, sperm from the reserve is loaded into the prostate urethra through the ejaculatory duct, until enough stimulation (orgasm) sperm is released into the vagina.
From the vagina, sperm pass through the cervix into the uterus and then into the fallopian tubes to the third third of the fallopian tubes, new sperm can meet the egg and fertilize here. As such, the male spermatozoa is very complex, and the female oviduct can also be considered a common pathway for both sperms.

Possible blockages are in the proximal testicles such as the reticulum, epididymis, and the beginning of the vas deferens. Obstruction in the distal segment: Distal vas deferens, seminal vesicles, ejaculatory ducts. To handle this blockage, there are currently two solutions: vasectomy surgery and surgery, sperm collection procedure.
Surgery to connect the vas deferens: It is applied to 3 cases: blockage in the epididymis (surgery to connect the vas deferens with the epididymis), blockage in the vas deferens in the scrotum (surgery to connect the vas deferens with the vas deferens. vas deferens) and blockage of the ejaculatory duct (endoscopic ablation of the vas deferens), while other blockages are hardly applicable due to the complicated structure and severe complications. Sperm collection procedures: Applied in cases of azoospermia, sperm can be collected from anywhere in the seminal tract. The seminal vesicles : This procedure is currently not applicable due to many complications, infections... Vasectomy : The procedure to extract sperm from the vas deferens (rarely applicable because of the complexity of the procedure, the risk of clogging the ducts, severe sperm damage), Epididymis : The procedure to extract sperm from the epididymis is applied frequently with two types: Percutaneous epididymectomy (PESA) and epididymal microsurgery Sperm-seeking testes (MESA). Testicles: Includes percutaneous needle aspiration (TEFNA) and testicular spermatomy (TESE) procedures.

Sperm are not produced, or are only produced very little at some point in the seminiferous tubules. Sperm collection procedures for non-obstructive azoospermia include:
Testicular tissue extraction surgery for spermatozoa (TESE) Testicular microsurgery to find sperm in testes Micro-TESE In azoospermia Do not block the treatment according to the cause to activate spermatogenesis, preserving fertility is the most important, not surgery because overuse of surgery will make the testicular tissue structure very large, especially in Micro-TESE surgery.
There are many surgical procedures for sperm collection, vasectomy, the choice of surgery and procedure needs to be considered very carefully depending on the patient's disease condition, professional level Doctor's (very important), equipment condition...

At Vinmec, we have successfully treated many cases of azoospermia men who have obtained sperm that are eligible for IVF and natural conception, not only that, but some of these patients are also tens of centimeters taller, sperm completely doubled or tripled, the penis was enlarged and increased by 4-5 cm. With a team of leading experts in male infertility treatment, reproductive support and a synchronous modern equipment system, comprehensive and professional medical examination, consultation and treatment services; civilized, polite, safe and sterile medical examination and treatment space.