Dr Roger Perkins
Male Fertility Specialist
- Micro TESE
- TESA
- Vasectomy reversal
Dr Roger Perkins | Male Fertility Specialist Perth
Micro TESE
Micro TESE is a highly specialised procedure and is undertaken by an andrology trained fertility specialist, in order to extract sperm from the testes. This type of procedure, as part of a fertility treatment, is recommended in cases where there is no sperm reaching the ejaculate. This is caused by damage to the sperm-making tubules in the testes.
Indication:
- Azoospermia caused by damage to testicular tissue.
Often the testes will measure smaller than normal and usually accompanied by pituitary hormone changes in a blood sample.
Causes:
- Undescended testes
- Chemotherapy as part of cancer treatment
- Injury to the testes
- Infection, such as STI
- Chromosomal disorder
- Genetic
- Sometimes the cause is unknown
Procedure:
This is carried out in the operating theatre under general anaesthetic. It is a day surgery procedure. Accompanying me in theatre are two scientists trained in identifying sperm from very tiny tissue samples. One or both testes are examined in minute detail using a powerful operating microscope after making an incision into the testis. The aim is to identify which particular area within the testis is producing sperm. A tiny sample is removed and immediately examined by the laboratory staff using a bench microscope in the operating theatre. In this way, only very small samples are removed, and I am able to judge immediately if the extraction was successful, or whether to continue searching. Typically, the seminiferous tubules which have sperm production are slightly plumper and more opaque in colour. The micro TESE technique makes sperm extraction more successful and also requires less tissue to be sampled than the older technique of simple random biopsies. The operation may take up to 4 hours. Overall success for sperm extraction is 50% of cases.
Micro TESE must be undertaken by a specialist in infertility with advanced andrology training and experience using the microscope, in order to be fully effective. I have gained the necessary experience and have been doing this procedure at my Perth practice for many of my patients.
Dr Roger Perkins | Perth Male Infertility Specialist
TESA
In cases where sperm production in the testes has not been damaged, but instead the azoospermia is caused by mechanical interruption to the passage of sperm, then it is a much simpler procedure to extract the sperm. This is called the needle TESA procedure.
Indications:
- Absence of the vas deferens from birth. Often this is associated with mutations of the cystic fibrosis gene.
- Previous vasectomy. In this situation the man also has the option of vasectomy reversal surgery.
- Retrograde ejaculation into the bladder caused by injury or disease.
- Spinal patients with no feeling below the waist.
Procedure:
We do this as a walk-in - walk-out outpatient procedure using local anaesthetic. The thought of having this done under local anaesthetic may cause anxiety, but in reality is very well tolerated and is very quick and effective. Sperm retrieval rates are typically close to 100%.
In each of these sperm retrieval techniques the sperm can be stored indefinitely, and is available for injecting into the woman’s eggs whenever she is ready to undertake IVF.
Dr Roger Perkins | Vasectomy Specialist Perth
Vasectomy reversal
I am fully experienced in vasectomy reversal and surgical techniques to retrieve sperm.
Vasectomy reversal is a procedure which is performed under anaesthesia using a powerful microscope. In this technique, the vas deferens are re-joined to allow natural conception. This is done as day surgery. Typical success rates for sperm presence in the ejaculate following reversal surgery are around 90%. Pregnancy rates reduce following long intervals since the original vasectomy, and therefore is best performed in under 10 years. This is because antibodies against sperm may develop over time and reduce sperm effectiveness. We are also able to store sperm collected at the same time of the vasectomy reversal, to be used later, if desired.
Alternatively, where the man prefers not to have another surgical procedure, it is very successful for sperm to be collected using a needle and local anaesthetic, and to use this sperm for ICSI treatment at a later date. This is called a TESA.
I also perform micro TESE, which is an advanced technique to find sperm in men with very damaged testes. Often the man will have a history of previous chemotherapy treatment or undescended testes which has left him with no sperm in the ejaculate. Sometimes a chromosomal or genetic condition is the cause.
Dr Roger Perkins | Andrologist Perth
Male infertility specialist
I work as a Fertility Specialist with both men and women in order to assist fertility. Men and women have differing conditions and need individualised care.
I have undertaken further training in Andrology to enable me to treat certain conditions unique to male fertility. It is important to look at the man as a whole and to treat appropriately. I am one of the only Fertility Specialists in Perth who has the skills to undertake these highly specialised male fertility procedures.
More about Dr Roger Perkins
IVF
Male Infertility
"My aim is to make you feel comfortable at all times. My consultation style is unrushed and I respect your schedule by minimising waiting times. You are a unique person and I make it my goal to truly get to know you."
