Surgical Sperm Retrieval
This procedure is offered to patients with certain ejaculatory disorders or no sperm in the ejaculate Surgical Sperm Retrieval gives a golden chance to father their own child by employing the IVF with ICSI treatment cycle.
Surgical sperm retrieval procedures
Men with absent sperms, very low sperms or in immotile sperms in semen can become father through intra-cytoplasmic sperm injection (ICSI) if sperm can be retrieved from their epididymis or testis.
Retrieval of epididymal or testicular sperm for ICSI is indicated in the following cases:
- Obstructive azoospermia – when reconstruction has failed, or is not possible (e.g. absent vas or multiple blocks following tuberculosis), or if the couple chooses ICSI over surgery.
- Non-obstructive azoospermia – in those men who have some areas of sperm production in testis.
- Failure to ejaculate during an IVF procedure (if vibrator stimulation fails and electro-ejaculation is not available).
- Abnormal sperm parameters – when all sperm are immotile in semen
Surgical Sperm Retrieval Techniques
MESA (Microsurgical Epididymal Sperm Aspiration) – It uses surgical microscope to retrieve sperms from epididymis (the tube through which sperm travel after leaving the testicle) under magnification done in general anaesthesia. If moving (motile) sperm are seen, the fluid is taken for immediate use or frozen for future use.
PESA (Percutaneous Epididymal Sperm Aspiration) – It can be done underlocal anesthesia. In this technique, the sperms are retrieved from epididymis through multiple pricks and fewer sperm are collected. With PESA, there are sometimes not enough sperm to freeze for later use.
TESE (Testicular Sperm Extraction) – Sperm can be taken directly from the testicle when there are no sperm in the epididymis and in cases of nonobstructive azoospermia. A needle is inserted (aspiration) or a tissue (biopsy) is taken through the skin which provides more amount of sample to retrieve sperms.
Microsurgical Testicular Sperm Extraction (Micro TESE) – Open testicular sperm extraction can be done with an operating microscope (microsurgical). The microsurgical technique has higher sperm retrieval rates than the conventional method. Sperm have been found with microsurgical TESE even when sperm production by the testicles is very low. Major advantages of using the micro TESE technique are the lower chance of injury to the testicular blood supply, less loss of testicular tissue, and less blood in the biopsy specimen.