Semen analysis
This is a simple test which basically counts the number and concentration of sperm in semen. It also tests the percentage of sperm that are swimming and those that look normal under the microscope. A semen sample should preferably be collected by masturbation after 3 days abstinence without sexual intercourse. It should arrive at the laboratory within one hour of collection. If for geographic reasons this time frame is not suitable then the sample should be collected at the fertility clinic. The clinic provides a small but private room. Both partners may be present if preferred provided that a semen sample is collected into the necessary container.
Sperm wash
This is a method of separating useful functional (fertile) sperm from the remainder of sperm in a semen sample. It gives a far more accurate assessment of male fertilizing capacity. It involves centrifuging a semen sample through a variety of different density solutions and then collecting the sperm that are able to swim out of the remaining concentrated sperm pellet.
Sperm Extraction - testicular biopsy & sperm aspiration
If there are no sperm seen at semen analysis or sperm wash then either testicular biopsy or sperm aspiration may be used to discover if they are present in the testis. Hopefully any sperm found can be frozen and stored, to permit use in later IVF and ICSI treatments.
The procedure - What happens to you
There are two ways of performing both testicular biopsy and sperm aspiration. The first involves the use of fine needles placed into the testis or its collecting tubes (epididymis) . This can be performed readily under local anaesthesia. The testis and surrounding structures can be effectively numbed by placing local anaesthesia around the vas deferens near the groin in the upper scrotum. The second method requires an open operation on the scrotum carried out under general anaesthesia involving a small cut in the testis and or a microsurgical collection of sperm from the collecting tubes.
What you have to do
This depends on your choice of methods: the local anaesthesia method involves an outpatient visit and a day off work. The general anaesthesia method involves day surgery and 2 or 3 days off work. Simply follow the instructions provided by the staff and attend at the allotted time. No special preparation is required.
Benefits & Advantages
In the one procedure both an accurate diagnosis and knowledge of whether treatment can be performed is obtained. Often (but not always) sperm collected at the time of these procedures can be frozen and then subsequently used for treatment (always involving both IVF and ICSI) at a later date.
Side effects & Complications
Discomfort from the injection of local anaesthesia occurs, as can allergic reactions although this is uncommon. Swelling of the testes or tubules afterwards can cause significant pain however, usually it is mild. Bleeding can occur into the testes or scrotum leading to bruising. Infection could uncommonly be introduced.