The treatment for Male Infertility has to be individualised keeping in view the duration of married life, presence of coital problems, reports of the wife - if they are normal or not, severity of the abnormal semen analysis report, age of the couple and duration of infertility. Various treatment modalities available at Janini IVF, the most transparent and honest IVF Treatment clinic in delhi NCR, include :
Antioxidant tablets or sachets Clomiphene citrate Injectable hormones (HMG, FSH) for Azoospermia or severe oligospermia. Indeed, HMG forms an integral part of treatment for a condition called Hypogonadotropic Hypogonadism Varicocele repair surgery ICSI (for oligospermia) MESA (micro surgical epididymal sperm aspiration) or PESA (per-cutaneous epididymal sperm aspiration) for OBSTRUCTIVE AZOOSPERMIA TESA (testicular sperm aspiration) or micro TESE (micro testicular sperm extraction) for Non-obstructive Azoospermia Testicular sperm mapping Electo and vibro ejaculation for patients with ejaculatory disorders Sperm freezing IMSI or PICSIOne of the best IVF centres of India, Janini IVF is one of the very few clinics that offer micro-TESE treatment for zero sperm count patients. Micro dissection TESE is the latest advent in the realm of Male Infertility management and it is nothing short of a miracle. Indeed, micro-TESE procedure has the HIGHEST CHANCE of harvesting sperm successfully even in those men who have had no sperm harvest in a previous TESA attempt. Considered to be the FINAL LINE OF MANAGEMENT of Non-obstructive Azoospermia, if even micro-TESE procedure which is performed by an experienced surgeon especially trained to perform it yields no sperms, then sperm donation is the only remaining option. Micro-TESE have given countless men a smile on their face to have their own genetic baby when everything else had failed earlier. Sperms found are not only used for ICSI but extra sperm are also FROZEN so that if there is a need we don’t need to go for a repeat procedure again.
How is micro-TESE done?
Dr. Dalal, one of the best surrogacy doctors in Delhi, had been fortunate to visit and learn from the best Andrology (Male Infertility) centre in the whole world - “Androfert” at Sao Paulo, Brazil under Dr Sandro Esteves. During micro-TESE which is usually performed under general anesthesia, the testis is opened surgically and visualised with a microscope (40x magnification). Areas which seem to have dilated, white, thick tubules are retrieved with forceps and passed into the embryology laboratory to check the presence of sperm. An intense search is continued until the Embryologist signals for a success or until 25-30 tissue samples are sent and no result is found.
How does micro-TESE give success when a simple TESA has failed?
A testis is a dynamic organ. When there is a damage in sperm production there are some pockets that remain that continue making sperm. In a blind procedure like TESA where only a needle in injected one cannot make out such areas so we miss out on them. But in a micro-TESE the entire testis is seen under magnification. So, if there are areas of sperm production, we will find sperm.
What determines success for micro TESE?
Micro TESE is an extremely skilful and delicate procedure. Easier said than done, even top urologist surgeons do not have the technical skill to perform it because of lack of exposure. Moreover, having a skilful surgeon alone is not enough. You need a very, very good Embryologist who will painstakingly scan every minute tubule of the testis FOR HOURS continuously and let the surgeon know about the presence of sperm. It is very difficult to generate this skill in the embryology side. Fortunately for Janini IVF, Dr. Mishra’s extensive years of experience come in handy and this is what differentiates Janini IVF from other IVF centres in Delhi. While at Lilavati Hospital Dr. Akanksha Mishra had extensive exposure to micro TESE procedures performed by Dr. Rupin Shah. People might claim to be having micro-TESE, but the chances of them telling you that they have used only your sperm is dismal. We, at Janini IVF, try our level best to use only your sperm as far as possible and most of the times we are successful in doing that. All extra sperm after ICSI are frozen so that we have a backup of those precious sperms also.
As micro TESE is invasive many patients ask why not we try putting a thin needle and checking for sperms first. If we find, well and good - we can use them for ICSI and our job is done. If we don’t - only then we go for a micro TESE procedure. So, taking this approach has the advantage that micro TESE can be avoided if TESA is successful. This approach is practical and has the advantage of having the best chance of finding sperm.
Disadvantage of this approach is giving general anaesthesia for TESA (we normally do it under local numbing agent) and extra time taken.
How is it done?
Step 1 - advanced testicular mapping is done by performing TESA on multiple sites of the testis. The sample is immediately scanned for sperm and if sperm are found the procedure is abandoned right here.
Step 2 - if no sperm is found with testicular mapping we proceed with micro TESE.
With simultaneous Mapping + micro TESE approach our patents at Janini IVF get the highest chance of using their own sperm for having a baby with least amount of surgery needed.
TESE is a simpler version of micro TESE where under local anaesthetic a small cut is made on the testis and a tiny bit of tissue sent to embryology lab. TESE at Janini IVF is only done for OBSTRUCTIVE Azoospermia patients who have no production problem. Patients with production problem of sperm (NON OBSTRUCTIVE AZOOSPERMIA) - micro TESE is more advisable as chances of finding sperm with a simple TESE is lesser than microTESE.
TESA is even simpler and quicker than TESE. In TESA all we do is put a thin needle inside the testis and aspirate the contents. This is done under local anaesthesia. TESA is preferred to be done where the production of sperm is not at fault, for example in Obstructive Azoospermia cases.
Per-cutaneous epididymal sperm aspiration and Micro-surgical epididymal sperm aspiration are minor procedures done to extract sperm in Obstructive Azoospermia cases. Here the advantage is instead of the testis, only the epididymis (a small tube behind the testis meant for sperm passage) is aspirated so the testis is left untouched. PESA or MESA cannot be done in cases where the sperm production is at fault.
Varicocele is an abnormal dilatation of the veins that drain the testicular area and happen because of failure of the valves. Varicoceles ARE ONLY RELEVANT IF THEY ARE VISIBLY LARGE. Those varicoceles that are not apparent but are diagnosed only on ultrasound ARE NOT HARMFUL OR RELEVANT.
Large varicocele can cause infertility due to pressure effects or by increasing free radical injury. It has been seen that removal of large varicoceles is followed by improvement in semen parameters and improvement in DFI number. Sometimes couples conceive naturally after Varicocelectomy. We at Janini IVF do offer varicocelectomy procedure for those who need it.
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