SPERM RETRIEVAL PROCEDURES FOR USE WITH IVF-ICSI
The most common reasons to combine sperm retrieval procedures with IVF-ICSI are either as an alternative to vasectomy reversal or as treatment for uncorrectable blockages of the sperm ducts such as occurs with congenital bilateral absence of the vas deferens (CBAVD). Small numbers of living sperm have also been retrieved from the testicles of men who do not have sperm duct blockages, but have an absence of sperm in the ejaculate due to sperm production problems in the testicle (non-obstructive azoospermia, NOA). Sperm may be retrieved from the epididymis or directly from the testicle depending on individual circumstance. This can be performed with an office-based needle aspiration under local anesthesia the same day as the IVF-ICSI egg retrieval, with just enough sperm for this single cycle (percutaneous epididymis sperm aspiration-PESA, or testicular sperm extraction-TESE). But, sperm retrieval in some cases is best achieved as a minor outpatient surgical retrieval with operating microscope control so as to obtain the highest quality and greatest quantity of sperm which can be frozen in multiple tubes for later use in multiple IVF-ICSI cycles, if needed (microsurgical epididymis sperm aspiration-MESA). Since IVF-ICSI has an approximately 50% to 60% ongoing pregnancy rate per cycle (varies somewhat from one program to another), it is reasonable to assume that you will need to pursue at least two IVF-ICSI cycles, hoping of course that you will get pregnant from your first cycle. As of 2005, average cost for IVF-ICSI in Dallas/Ft. Worth is $13,000 per attempt and may vary from one program to another. Retrieving the sperm and freezing them in advance of the ICSI cycle (MESA) has several advantages including the mental comfort of knowing that you have sperm "ready-to-go" and that you can focus attention on your partner's ICSI cycle and her physical and emotional needs on that day. Although many ICSI programs have a preference for using fresh sperm, we have found no significant difference in pregnancy rates between frozen and fresh sperm used in ICSI cycles so long as the sperm are from the epididymis. Frozen-thawed testicular sperm do not do as well as fresh testicular sperm, but they are an acceptable "back-up."
Insurance and Cost: In the majority of cases, these procedures are not covered by your insurance unless your insurance covers IVF. We can give you the information you need in order to check with your insurance carrier. The cost of the sperm retrieval procedures can range from approximately $1800 for in-office PESA/TESE to $4300 for outpatient MESA. The more expensive MESA procedure has the advantage of providing enough frozen epididymal sperm for up to 4 IVF-ICSI cycles. Our goal is to help you choose the most cost-effective procedure for your situation, and to minimize the number of times the sperm retrieval procedure needs to be performed.
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