Having children is one of the most important matters in couples’ lives, as it brings happiness and psychological comfort. However, there are many problems they may face in achieving this goal, and one of the prominent issues is zero sperm count or the absence of sperm in the semen.

Zero sperm count is one of the most challenging problems for couples wishing to conceive, as the chances of pregnancy become nearly impossible without the extraction of sperm from the testicle through surgical incision and searching for sperm. Due to the sensitivity of the area and the pain of the surgery, many men avoid undergoing testicular opening surgery to search for sperm due to the fear of complications, which reduces the chances of finding sperm inside the testicle and restricts the couple’s chances of conceiving.

Fortunately, there is progress in the field of medicine that can offer new hope to these couples. Professor Dr. Adham Zaazaa, MD – Consultant in Andrology and Surgery, has invented SIVCA technique (Standard IV Cannula Aspiration) that is beneficial for couples who suffer from zero sperm count, because it provides an opportunity to obtain sperm suitable for use in assisted reproductive techniques, effectively, safely and without surgical intervention, thus increasing the chances of pregnancy and conception.

SIVCA technique is a new revolution in andrology and ICSI:

The new technique, Standard IV Cannula Aspiration (SIVCA), was invented and developed by Professor Dr. Adham Zaazaa, MD – Consultant in Andrology, to provide a complete inspection of sperm and was first presented at the European Society of Human Reproduction and Embryology (ESHRE) Annual Meeting in Milan, Italy, in 2022.

This new technique has gained the admiration of the scientific community, including specialized fertility doctors and surgeons in various countries around the world. Therefore, Professor Dr. Adham Zaazaa introduced and trained more than a hundred doctors from different countries on this technique at the European Society of Human Reproduction and Embryology Annual Meeting in Milan, Italy, in June 2022. Subsequently, this technique has been used in many specialized fertility and ICSI centers worldwide. SIVCA technique is considered a qualitative leap in andrology and ICSI procedures, as it enables surgeons to search for sperm throughout the testicle without the need for surgical incision.

Let us first explain the traditional methods of searching for sperm and their drawbacks, to understand the superiority and excellence of SIVCA technique in overcoming these drawbacks.

Traditional methods for sperm retrieval:

SIVCA technique has made the search for sperm in cases of zero sperm count and absence of sperm in semen easier, revolutionizing ICSI. Previously, doctors resorted to only two methods for extracting sperm: surgical opening by TESE or needle aspiration through FNA.

– Testicular Sperm Extraction (TESE) involves surgically opening the testicle entirely to search for and retrieve sperm. This procedure causes pain to the patient and requires a long recovery period that may extend to two weeks, with a surgical incision in the scrotum that needs daily dressing changes throughout this period. Additionally, surgical incision of the testicle can lead to fibrosis of testicular tissues, making subsequent surgical openings for further attempts to find sperm more challenging.

– Fine Needle Aspiration (FNA) involves extracting sperm from the testicle through suction using a fine needle. It is an effective, minimally invasive, and cost-effective procedure that does not require general anesthesia. However, the 23G needle does not provide a sufficient quantity of testicular tissues for the effective search and extraction of sperm. Additionally, the needle is made of hard stainless steel, which can cause tears and bruises within the testicular tissue. Furthermore, it is short and not long enough to reach deep into the testicle for a thorough search and retrieval of sperm. These problems were avoided using SIVCA technique.

SIVCA Technique:

SIVCA technique is one of the innovative techniques used in the microscopic search for sperm in cases of zero sperm count and absence of sperm in semen, whether due to testicular dysfunction or obstruction of the ducts.

This technique aims to precisely and microscopically search for sperm in all areas of the testicles through a single, extremely small opening not exceeding one millimeter in diameter by inserting a transparent, flexible, and smooth tube made of polytetrafluoroethylene (PTFE) material into the testicles, without any surgical incision, to extract tissues for sperm search to be used in assisted reproductive techniques such as intracytoplasmic sperm injection (ICSI).

Steps of SIVCA Technique:

After local anesthesia, Professor Dr. Adham Zaazaa inserts a thin, smooth, and flexible tube made of polytetrafluoroethylene (PTFE) material into the testicles without any surgical incision. By applying a constant and extremely low negative pressure, he extracts sufficient tissues from various parts of the testicles to cover as many testicular areas as possible. Polytetrafluoroethylene (PTFE) material allows the surgeon to examine the extracted testicular tissues using a surgical telescope while they pass through the tube.

Advantages of SIVCA technique compared to traditional surgery:

SIVCA technique has several advantages compared to traditional surgery in cases of zero sperm count. Here are some of these advantages:
1- Non-surgical intervention: In the case of using SIVCA technique, it does not require the testicle to be incised or surgically opened, which means there is no need to cut testicular tissues or create a surgical incision, reducing the potential risks and complications.
2- Less invasive and less painful: SIVCA technique is considered a less invasive procedure compared to traditional surgery. The procedure is performed under local anesthesia, reducing the pain and stress associated with the surgery.
3- Effective and accurate: SIVCA technique allows the retrieval of sufficient amounts of tissues and microscopic inspection in all areas of the testicles.
4- Shorter recovery time: Due to the limited intervention with no need for surgery, the recovery time after SIVCA technique is usually much shorter than that of traditional surgery, which can extend up to two weeks. Patients can return to their daily activities more quickly, often within 48 hours of undergoing SIVCA technique.
5- Safety: SIVCA technique is generally considered safe and low-risk. Compared to traditional surgery, potential surgical complications such as bleeding, infection, and significant scarring in the scrotal sac are avoided.

In summary, SIVCA technique offers several advantages over traditional surgery in cases of zero sperm count. It combines the benefits of needle aspiration by being less invasive and the microscopic inspection by allowing the extraction of sufficient quantities of tissues from all areas of the testicles and examining these tissues under a surgical microscope during extraction. Therefore, it is a less invasive and painless procedure, with faster recovery, and without potential surgical complications.

Advantages of SIVCA technique compared to needle aspiration:

Needle aspiration may cause tears in the testicular tissues due to the nature of the needle used. Additionally, the small diameter of the needle does not allow for the retrieval of sufficient tissues, so it may be used in cases of obstruction where the presence of an adequate number of sperm is certain or in extracting diagnostic samples to investigate the causes of the absence of sperm.

On the other hand, SIVCA technique does not cause any tears or bruises to the testicular tissues as it uses a flexible tube. Additionally, the length of the tube allows for reaching the depths of the testicles and retrieving sufficient tissues, unlike needle aspiration.

Frequently Asked Questions about SIVCA Technique:

Does SIVCA technique end the need for surgical intervention?
In most cases, SIVCA technique provides sufficient tissue for sperm retrieval, eliminating the need for surgical intervention in 97% of cases.

Are there men who will not benefit from SIVCA technique?
It should be noted that SIVCA technique is not suitable for all cases of azoospermia (zero sperm count), and there may be exceptional cases that require traditional surgery. Therefore, it is advisable to consult with Professor Adham Zaazaa, Consultant in Andrology and Reproductive Medicine and Surgery at the Faculty of Medicine, Cairo University, to determine the best suitable options for each case.

Among these cases are:
– Severe testicular atrophy does not allow the insertion of the catheter necessary for tissue retrieval. These cases require undergoing traditional surgical extraction.
– SIVCA technology allows sufficient tissue extraction in 97% of cases. If the necessary amounts of tissue cannot be retrieved as in the case of severe testicular fibrosis, TESE surgical intervention would be the ideal option to obtain enough testicular tissue.

What are the success rates of SIVCA technique?
The success rate of SIVCA technique, so far, for cases that have undergone this newer technique, can be divided into two parts:
– The chance of sperm retrieval from the testicles is equivalent to the success rate achieved through surgical intervention, which averages 54% of men with testicular dysfunction.
– The rate of retrieving sufficient amounts of tissue reaches 97% of men.

Does SIVCA technique benefit cases of azoospermia after surgical testicular opening?
Certainly, SIVCA technique benefits men who have lost hope after undergoing surgical testicular opening without finding any sperm.
After undergoing the appropriate treatment period, the search for sperm is conducted using SIVCA technique instead of a second surgical incision with its associated pain and complications. This is because SIVCA technique allows for the examination of the entire testicles without surgical incision, with less pain and a shorter recovery period. These advantages give these men hope that they will be able to try again if their condition requires that.

Azoospermia represents an obstacle to the dream of parenthood. However, it can be treated with the latest therapeutic techniques by Professor Adham Zaazaa, Consultant in Andrology and Reproductive Medicine and Surgery at the Faculty of Medicine, Cairo University. He has excelled in inventing the safe and non-surgical SIVCA technique, which is a significant step in treating azoospermia, providing an opportunity for couples affected by this condition to achieve the dream of having children.