Alternatives

Recent breakthrough in IVF enables us to achieve pregnancy with a very small number of sperm. In men with production problems or obstruction not amenable to surgical reconstruction, directly obtaining sperm from the testicle or epididymis for IVF is the only option for biological parenthood.

Sperm aspiration/extraction with IVF/ICSI is an alternative to surgical reconstruction. There are pros and cons for each approach; in my opinion, vasectomy reversal is more appropriate for most men, if one considers the likelihood of success and overall costs.

Testicular and epididymal sperm are functionally immature. They are not very motile and most do not have the ability to home in on the eggs, even if they are placed together in a test tube. They must be directly injected into the eggs to achieve fertilization through a procedure called IVF/ICSI.

Testicular and epididymal sperm cannot be used for intrauterine insemination due to their functional immaturity and the low number of such sperm retrievable. Their use requires IVF/ICSI.

The sperm may be sucked out with a small needle (aspiration) or processed out from a small piece of testis tissue (extraction). Aspiration can only be used in men with normal sperm production; it is less traumatic but removes only a very small number of sperm, too few for sperm banking, but sufficient for immediate use.

We strongly recommend that you become well-informed of all aspects of these options before reaching a decision. We are here to help you, and we look forward to the opportunity to discuss with you the various options available and answer any questions you may have.

Dr. Agha performs microscopic epididymal sperm aspiration (MESA) and TESA. We have a state of the art IVF team and routinely perform MESA and ICSI for IVF

Our In vitro Fertilization Program

We work in collaboration with Reproductive Medicine Institute  (RMI) for patients who wish to pursue IVF. The RMI provides all assisted reproductive techniques (ARTs), including in vitro fertilization/embryo transfer (IVF/ET), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and tubal embryo transfer (TET), with and without micromanipulation. The micromanipulation techniques include intracytoplasmic sperm injection (ICSI) and assisted zona hatching (AZH). The IVF laboratory is directly attached by pass-through windows to the ultrasound guided oocyte retrieval room and the operating room where procedures such as GIFT, ZIFT, and TET are performed.

Pass-through retrieval eliminates the unnecessary and potentially harmful effect of transport on the gametes and embryos. The overall results of our IVF program in terms of the take home baby rate have consistently been above the national average. OBFC staff has been actively involved in clinical and basic researches, and participates in several multi-center clinical trials. The results of these studies have lead to the development of new techniques and high success rates. During the past two years, we have introduced new IVF stimulation protocols, embryo co-culture and blastocyst transfer procedures which have further improved our success rates and allowed a decrease in the number of embryos transferred, reducing the risk of multiple gestation.

Recently we have demonstrated an adverse effect of autoantibodies on the IVF outcome in women with endometriosis and were able to improve the results with specific treatment (Fertility and Sterility, March 1995).

Our donor egg IVF program was the first established in the Midwest and had the first pregnancy. We have recently reported that high pregnancy rates can be achieved in donor egg recipients with poor endometrial growth when novel form of estrogen replacement is used (Journal of Assisted Reproduction and Genetics, March 1997).