Surgical sperm retrieval may be a treatment option for men with:
- An obstruction preventing sperm release, due to injury or infection
- Congenital absence of the vas deferens (men born without the tube that drains the sperm from the testicle)
- Non-obstructive azoospermia - the testicles are producing such low numbers of sperm that they don't reach the vas.
In the first three conditions, sperm are produced by the testes, but are unable to be ejaculated because of the blockage or absence of the vas. The man can still ejaculate seminal fluid but this fluid will not contain any sperm. It is possible to collect sperm directly from the epididymis or testis.
Occasionally it may be possible to surgically unblock the tube that carries the sperm during the ejaculation process, although this has a low success rate. In cases of vasectomy, surgical correction in the form of vasectomy reversal may offer another treatment to this problem. In cases of non-obstructive azoospermia (complete absence of sperm) very small amounts of sperm may be produced (FOCAL SPERMATOGENESIS) and can be collected directly from the testes. This is done by performing multiple testicular sampling at random. In these cases a biopsy will normally be sent to the laboratory for analysis as to the possible cause of the problem.
In men with obstructive azoospermia there is a very high chance of recovering sperm by this method (>90%). In men with non-obstructive azoospermia the chances of recovering sperm is approximately 40%. If we are successful at retrieving sperm the pregnancy rate for this treatment is very similar to that of ICSI with ejaculated sperm.
PESA (Percutaneous epididymal sperm aspiration) is the collection of sperm through a fine needle directly from the epididymis, where sperm is stored, after it is formed in the testes.
TESE (Testicular sperm extraction) is the collection of sperm from a biopsy or several biopsies from the testicular tissue after making a small incision in the scrotal skin.
The above procedures are carried out either under light general anaesthetic combined with the use of a local anesthetic. It requires only a few hours of hospital stay. The material collected will be examined and you will be advised on the same day about the quality of the material and whether there is any sperm present. Any material with sperm will be frozen and place in storage for use at a later stage. These specimens are then thawed and used to inject the eggs obtained during ICSI. If surgical retrieval of sperm is successful, usually enough sperm is obtained for several cycles of treatment (if required).
MICRO TESE is an advanced technique to retrieve sperms even in case of focal spermatogenesisand requires lot of expertise.