Control of high-risk pregnancies, diagnosis and treatment of fetal problems
Diagnostic laparoscopy may be recommended to look at the outside of the uterus, fallopian tubes, ovaries, and internal pelvic area. Diagnostic hysteroscopy is used to look inside the uterine cavity.
Laser-assisted hatching can turn around a history of failure for embryos to implant themselves in the uterine wall. Assisted hatching is used to help the embryo hatch from its protective outer shell, the zona pellucida, and promote implantation in the uterine wall after embryo transfer.
Testicular sperm extraction (TESE) is the surgical procedure of removing a small portion of tissue from the testicle and extracting any viable sperm cells from that tissue for use in further procedures, most commonly intracytoplasmic sperm injection (ICSI) as part of in vitro fertilisation (IVF). TESE is often recommended to patients who cannot produce sperm by ejaculation due to azoospermia
TESE is recommended to patients who do not have sperm present in their ejaculate, azoospermia, or who cannot ejaculate at all. In general, azoospermia can be divided into obstructive and non-obstructive subcategories.
TESE is primarily used for non-obstructive azoospermia, where patients do not have sperm present in the ejaculate but who may produce sperm in the testis. Azoospermia in these patients could be a result of Y chromosome microdeletions, cancer of the testicles or damage to the pituitary gland or hypothalamus, which regulate sperm production. Often in these cases, TESE is used as a second option, after prior efforts to treat the azoospermia through hormone therapy have failed.
However, if azoospermia is related to a disorder of sexual development, such as Klinefelter syndrome, TESE is not currently used clinically; this is currently in the research phase.
More rarely, TESE is used to extract sperm in cases of obstructive azoospermia. Obstructive azoospermia can be caused in a variety of ways:
TESE can also be used as a fertility preservation option for patients undergoing gender reassignment surgery and who cannot ejaculate sperm.
Percutaneous epididymal sperm aspiration
Percutaneous epididymal sperm aspiration (PESA) is a technique used to determine sperm counts in the event of a possible blockage of the vas deferens. It is an alternative to microepidydimal sperm aspiration (MESA), and aims to address the technical difficulty and cost of MESA.
A small needle is inserted through the skin of the scrotum to collect sperm from the epididymis, where sperm are usually stored after production in the testes. It can also be used to extract sperm for intracytoplasmic sperm injection (ICSI)
