Is It Possible to Perform IUI Using Aspirated Sperm?

If you and your partner have been trying to conceive for over a year without success, it can feel frustrating and disheartening. There are many reasons why you might be having difficulty conceiving, and one possibility is male-factor infertility, which is characterised by an absence or low number of sperm in the semen (azoospermia).

To support you during this fertility journey, your fertility specialist may recommend fertility treatments combined with sperm retrieval procedures to help you welcome your little angel into the world.

What is an aspirated sperm?

Aspirated sperm is sperm that's retrieved artificially through a surgical procedure (sperm extraction) or through needle-guided procedures that withdraw sperm directly from the testicles or epididymis, also known as sperm aspiration.

Your doctor will usually recommend this procedure if you are experiencing male infertility issues that prevent sperm from appearing in your semen during ejaculation. This condition can be caused by:

Obstructive azoospermia

This condition occurs when your testicles produce sperm normally, but a physical blockage causes the sperm to be trapped within your reproductive tract, usually in the epididymis or vas deferens. Common causes include:

• Abnormal cyst or growth

• Trauma or injury to the testicle

• Blockages from injury or surgery

• Infections that lead to inflammation, such as epididymitis (inflammation of the epididymis)

• Reproductive tract blockage due to a vasectomy or the congenital absence of the vas deferens.

Non-obstructive azoospermia

As the name implies, non-obstructive azoospermia means that there’s no blockage or obstruction interfering with the sperm transportation from the epididymis to the urethra. Instead, this condition results from severely impaired or absent sperm production within your testicles. Common causes include:

• Severe varicocele (enlarged veins in the scrotum)

• Hormonal imbalances, such as low testosterone

• Previous chemotherapy or radiation treatment

• Certain medications or steroid use that affect sperm production

• Genetic conditions such as Klinefelter syndrome or Kallmann syndrome

• Lifestyle factors such as excessive alcohol consumption, smoking, or prolonged exposure to high temperatures

Additionally, a sperm retrieval procedure may be required for certain fertility conditions, such as severe oligospermia (a very low sperm count) or necrospermia (a high percentage of deceased sperm).

For further information on whether sperm retrieval procedures could help you conceive, schedule an appointment with Thomson Fertility Centre. Our fertility specialists can help determine whether these procedures are suitable for your fertility condition.

How does the doctor retrieve your sperm?

If you have been diagnosed with male infertility, depending on the cause of your condition, there are a few methods your fertility doctor can use to retrieve your sperm.

For obstructive azoospermia:

If your fertility issues are caused by blockages in the reproductive tract that prevent sperm from being released through ejaculation, your doctor can perform several procedures.

• Percutaneous epididymal sperm aspiration (PESA):

  • PESA is a minimally invasive procedure where your doctor carefully inserts a fine needle through the scrotum's skin directly into the epididymis to retrieve sperm.

  • However, since this procedure is performed without direct visualisation, your doctor cannot say exactly where the needle is located in the epididymis. This limitation can sometimes make it difficult to obtain sufficient sperm for use in fertility treatment.

• Microsurgical epididymal sperm aspiration (MESA):

  • During a MESA procedure, your surgeon will make a small incision in your scrotum and use a surgical microscope to visualise and access your epididymis directly.

  • This method is often chosen because the microscope helps your doctor identify areas suitable for sperm collection and may allow for the retrieval of larger quantities of sperm compared to PESA, though individual outcomes vary

• Testicular sperm aspiration (TESA):

  • Unlike MESA and PESA, TESA involves aspirating sperm directly from your testicles rather than the epididymis. 

  • To perform it, your doctor makes a small puncture in your scrotal skin and uses a spring-loaded biopsy needle to collect testicular tissue that contains sperm.

  • TESA may retrieve sperm, though the quantity of tissue collected can vary and may sometimes be limited, which can affect its suitability for certain fertility treatments. This can sometimes make it challenging to use the retrieved sperm for fertility treatment.

For non-obstructive azoospermia

If your fertility issues are caused by non-obstructive azoospermia, which is characterised by severely impaired or absent sperm production in the testicles, then surgical sperm retrieval becomes necessary.

• Testicular sperm extraction (TESE):

  • TESE involves making a small incision in the scrotum and surgically removing a small piece of testicular tissue to be examined for the presence of sperm.

  • The tissue is immediately examined in the laboratory to identify viable sperm that can be used for fertilisation.

  • You may experience some discomfort after the procedure. Your doctor will provide post-procedure care instructions and arrange follow-up appointments to support your recovery.

• Microsurgical TESE:

  • Microsurgical TESE, also known as micro-TESE, is a more advanced sperm retrieval technique that uses microsurgery to carefully examine testicular tissue.

  • While you're under general anaesthesia, your surgeon uses a surgical microscope to carefully examine your testicular tissue and identify areas most likely to contain sperm. The microscope helps locate which tubules within your testicle have the best chance of containing viable sperm.

  • During the procedure, small tissue samples are sent to the laboratory to determine whether sufficient sperm have been harvested for your treatment cycle.

Can you do intrauterine insemination (IUI) with aspirated sperm?

In some cases, aspirated sperm may be used for IUI, though there are important considerations regarding its suitability, including the motility and quality of the retrieved sperm. This is because sperm obtained from aspiration procedures, particularly in cases of non-obstructive azoospermia, may not be suitable for IUI due to their potential lack of motility and low quality.

However, IUI with aspirated sperm is possible if the retrieved sperm is sufficiently mobile and has a normal shape. If the sperm is properly processed and washed to select those most suitable for insemination, it may be suitable for use in IUI, though outcomes vary depending on the quality and motility of the retrieved sperm and other individual factors.

For the best results, many fertility specialists recommend combining sperm aspiration with intracytoplasmic sperm injection (ICSI) during IVF rather than IUI. ICSI involves injecting a single sperm directly into an egg, which means it does not rely on the sperm's ability to swim and penetrate the egg independently. This may make it a suitable option in cases where sperm motility or quantity is a concern.

To help increase your chances of conceiving, our fertility specialists at Thomson Fertility Centre can evaluate your aspirated sperm sample and advise on which fertility treatment may be most appropriate for your individual circumstances. Schedule an appointment with us today.

What are the alternatives to IUI using aspirated sperm?

If your doctor determines that IUI with aspirated sperm isn't the most suitable option for your fertility condition, there are other assisted reproductive technologies (ART) available to help you achieve pregnancy, including:

In vitro fertilisation (IVF)

In vitro fertilisation (IVF) is a type of ART where sperm and eggs are fertilised outside of the body. During the IVF process, your doctor will extract a mature egg from your ovaries. The aspirated sperm and eggs are combined in an incubator to facilitate fertilisation following the egg retrieval process.

After successful fertilisation, the fertilised egg (embryo) will be transferred back into your womb, where it can implant in the uterine lining and develop into a pregnancy. A complete IVF cycle typically takes around 4 to 6 weeks, though the duration can vary depending on individual circumstances and how the body responds to treatment.

Intracytoplasmic sperm injection (ICSI)

ICSI is a specialised type of IVF that effectively utilises aspirated sperm. During ICSI, a single sperm is directly injected into a mature egg to achieve fertilisation to achieve fertilisation instead of placing sperm and eggs together and waiting for natural fertilisation to occur.

In standard IVF, sperm and eggs are placed together to allow fertilisation to occur naturally, while ICSI involves the direct injection of a single sperm into the egg. This technique may be considered in cases of severe male infertility where natural fertilisation is not possible, as it bypasses the need for sperm to swim and penetrate the egg independently.

If fertilisation occurs, the resulting embryo is monitored in the laboratory before being considered for transfer to the womb, where it may implant and develop.

FAQ

How can sperm aspiration lead to pregnancy?

Can unwashed sperm be used for IUI?

Can you do IUI with frozen sperm?

Is IUI possible with a TESE?

Which is better, TESE or PESA, for sperm aspiration?

What makes a sperm sample suitable for IUI?

The information provided is for general guidance only and should not be considered as medical advice. For a personalised fertility consultation and tailored advice, schedule an appointment with Thomson Fertility Centre today.