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Submitted by Dr. Hesham Al-Inany, M.D. Lecturer, Gynaecology
& Obstetrics dept. Kasr El-Aini hospital, Cairo University, Egypt.
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During Gamete Micromanipulation sperms are injected into an ovum to assist in
union of the gametes.
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Microsurgical aspiration of epididymal sperm
It is estimated that between 10% and 25% of all men with obstructive
azoospermia have congenital absence of the vas deferens (Patrizio et al,
1990).
Microsurgical epididymal sperm aspiration followed by assisted fertilization
either IVF or gamete micromanipulation was developed for treatment of
male infertility because of obstructive azoospermia 2ry to congenital
absence of the vas deferens (Silber, 1988).
Human epididymal sperm exhibits markedly worse motility, progression and
morphology than ejaculated sperm. Also, epididymal samples are frequently
contaminated with varying degrees of red blood cells and depending on
the site of aspiration, debris, large number of macrophages and degenerated
sperm (Ord et al, 1992).
A 26-year-old nulliparous woman conceived after transfer of three embryos
cocultured on Vero cell monolayer. The ET followed SUZI of epididymal
sperm from her husband with congenital absence of vas deferens (Soong
et al, 1993).
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Technique
Scrotal contents are extruded through small incision, the tunica vaginalis
is opened and the epididymis is exposed. Under 10-40 times magnification
with an operating microscope, a tiny incision is made with microscissors
into the epididymal tunic to expose the tubules in the distal-most portion
first of the congenitally blind-ending epididymis.
Sperm is aspirated directly from the opening in the epididymal tubule
with a 22 medicut on a tuberculin syringe. Great care is taken not to
contaminate the specimen with blood, and careful homeostasis is achieved
with a micropolar forceps. The epididymal fluid is immediately diluted
in HEPES buffered media, and a tiny portion is examined for the motility
and quality of progression.
In the laboratory, the epididymal sperm is concentrated into a volume
of 0.3ml, layered on a discontinuous mini-Percoll gradient, and centrifuged
for 30 min. The entire 95% fraction is then washed .
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