SIVCA: A Hope for Men with Azoospermia

For men struggling with infertility due to azoospermia, the complete absence of sperm in their ejaculate, achieving fatherhood can feel like an impossible dream. Traditional surgical sperm retrieval methods, like micro-TESE (microsurgical testicular sperm extraction), while effective, involve multiple incisions in the scrotum and require general anesthesia. This can be a daunting prospect for many men, leading to treatment delays and emotional distress.

However, a new minimally invasive technique called SIVCA (Standard IV Cannula Aspiration) is offering renewed hope. SIVCA utilizes a wider needle called a standard IV cannula to extract testicular tissue samples through a single puncture site. This significantly reduces the invasiveness of the procedure compared to micro-TESE.

The Novelty of SIVCA

SIVCA is a relatively young technique, first described in medical literature in 2016. While established methods like micro-TESE have a proven track record, SIVCA offers several advantages:

Minimally Invasive: The single-puncture approach of SIVCA minimizes tissue trauma and discomfort for the patient. This can lead to a faster recovery time and potentially lower the risk of post-operative complications.

Outpatient Procedure: SIVCA can often be performed on an outpatient basis, eliminating the need for an overnight hospital stay. This reduces overall healthcare costs and allows men to return to their daily routines quicker.

Reduced Scarring: With only one small incision site, SIVCA leaves minimal scarring compared to micro-TESE, which may require multiple incisions.

Safety Profile of SIVCA

Studies have shown that SIVCA is a safe and effective procedure for sperm retrieval. A key benefit is the reduced risk of bleeding and infection associated with a minimized surgical approach.

While some discomfort and swelling are to be expected after any surgical procedure, SIVCA generally offers a quicker recovery with less post-operative pain compared to micro-TESE. This can be particularly beneficial for men who may be apprehensive about undergoing a more extensive surgery.

A Boon for Men with Azoospermia

Azoospermia can be caused by various factors, including blockages in the male reproductive system (obstructive azoospermia) or problems with sperm production within the testicles (non-obstructive azoospermia). Both types can benefit from SIVCA.

For men with obstructive azoospermia, traditional sperm retrieval methods like PESA (percutaneous epididymal sperm aspiration) may be sufficient. However, for men with non-obstructive azoospermia, where sperm production is impaired within the testes, micro-TESE was the only option.

The minimally invasive nature of SIVCA makes it a more approachable option for men with non-obstructive azoospermia who may have been hesitant to undergo a more extensive surgery like micro-TESE. This can significantly increase their chances of pursuing fertility treatments like IVF or ICSI and achieving their dreams of fatherhood.

The Road Ahead for SIVCA

SIVCA has shown promising results, and is being established as a standard sperm retrieval technique. Additionally, refining the technique and training more urologists and andrologists in SIVCA will make it more widely available to men seeking minimally invasive sperm retrieval options.

For men with azoospermia, SIVCA offers a beacon of hope. This innovative technique provides a minimally invasive and potentially safer alternative to traditional surgical sperm retrieval methods. As research continues and SIVCA becomes more widely available, it has the potential to significantly improve the lives of men struggling with infertility and pave the way for them to build families.

SIVCA stands for Standard IV Cannula Aspiration. It is a minimally invasive surgical procedure used to retrieve sperm directly from the testicles for use in assisted reproductive technologies (ART) like in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

This sperm retrieval technique is considered to be less invasive than traditional methods such as micro-TESE (microsurgical testicular sperm extraction), which requires multiple incisions in the scrotum. SIVCA typically involves just a single puncture site.

Here’s a breakdown of the SIVCA procedure:

• After general anesthesia, local anesthesia is administered to numb the area.
• A small 2mm incision is made in the scrotum.
• A wide 14G Teflon Cannula called a standard IV cannula is inserted into the testis.
• A Lock-luer syringe attached to the cannula is used to create 250Torr of suction and withdraw tissue samples.
• The tissue samples are examined while being aspirated with a surgical telescope and later for sperm under a microscope.
• If sperm are found, they can be used for ICSI or cryopreserved (frozen) for later use.

SIVCA is a relatively new procedure, but studies have shown that it is effective in retrieving sperm for use in IVF and ICSI. One study published in the journal Human Reproduction found that SIVCA was successful in retrieving sufficient testicular tissue for  sperm searching in 93% of cases [1]. New updates and modifications to the technique have improved the efficiency of SIVCA this to 97% and is due to be published in 2024.

Advantages of SIVCA

• Minimally invasive
• Requires only one puncture site
• Less pain and faster recovery
• Lower risk of complications compared to micro-TESE
• Reaches the depth of the testes for a more extensive sperm searching

Disadvantages of SIVCA

• Not as widely available as micro-TESE
• May not be suitable for all men, for example men with very atrophic or fibrotic testes.

If you are considering SIVCA, it is important to talk to your doctor about the risks and benefits of this procedure to determine if it is the right option for you.

A Zaazaa, M Elbitar, R Elnabarawy, M. A Youssef, P-076 Standard IV cannula aspiration of testicular sperm: A novel, efficient and minimally invasive aspiration technique, Human Reproduction, Volume 37, Issue Supplement_1, July 2022, deac107.072, https://doi.org/10.1093/humrep/deac107.072