Surgical Sperm Retrieval
What is Surgical sperm retrieval?
Surgical sperm retrieval is a method where sperm is directly collected from the Epididymis or the Testis. That sperm can be used to achieve fertilization of eggs and help men father a child.
However, because the number of sperm that is retrieved is often very low, and their motility is also low, it is necessary to do ICSI to help fertilize the egg in the laboratory. If a good number of sperms are retrieved, it is possible to freeze/cryopreserve the extra sperms for future use. The sample can then be thawed and used for subsequent treatment when required.
Who requires Surgical Sperm Retrieval?
Surgical sperm retrieval may be a treatment option for men with:
1) Obstructive Azoospermia: A condition in which the fluid released from the penis will not contain sperm due to:
- An obstruction in the reproductive tract 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).
- Vasectomy is done earlier.
In these three conditions mentioned above, the man can still ejaculate seminal fluid but this fluid will not contain any sperm.
Occasionally it may be possible to surgically unblock/reconstruct the tube that carries the sperm during the ejaculation process, although this has a low success rate and may not be possible in all cases.
In cases of Vasectomy, surgical correction in the form of vasectomy reversal may be offered as another treatment option for this problem.
In men with obstructive azoospermia, there is a very high chance of recovering sperm by Surgical Sperm Retrieval (>90%).
2) Non-obstructive Azoospermia: A condition in which the fluid released from the penis will not contain sperm as the Testicles are producing such low numbers of sperm that they do not reach the Vas.
In cases of non-obstructive azoospermia (complete absence of sperm), very small amounts of sperm may be produced and can be collected directly from the Testes.
In men with Non-obstructive Azoospermia, the chance of recovering sperm is approximately 40% and it depends on the testicular sperm production. If we are successful at retrieving sperm the pregnancy rate for this treatment is very similar to that of ICSI with ejaculated sperm.
3) Severe Asthenozoospermia / Necrozoospermia – When most of the sperms are non-viable and immotile, it is necessary to use sperm aspirated from the testis since these are usually viable and may sometimes even be motile.
4) Erectile Dysfunction or Ejaculatory Dysfunction: If medication, vibratory stimulation or electroejaculation has failed, Surgical Sperm Retrieval may be used.
What are the types of surgical extraction available?
PESA (Percutaneous Epididymal Sperm Aspiration)
PESA is a simple procedure which does not require a surgical incision. It involves the insertion of a small needle attached to a syringe into the epididymis and fluid is aspirated by the Surgeon for sperm retrieval. This fluid is examined under the microscope by the Embryologist for the presence of sperm cells. The sample is then processed and used for ICSI or frozen for later use.
TESA (Testicular Sperm Aspiration)
TESA does not require a surgical incision. It involves the insertion of a needle attached to a syringe into the testis for retrieval of testicular tissue. TESA is usually done when no sperm has been retrieved with PESA. This tissue is then examined under the microscope by the Embryologist for the presence of sperm cells. The sample is then processed and used for ICSI or frozen for later use.
TESE(Testicular Sperm Extraction)
TESE involves a small incision given on the Scrotum and Testis to take a small sample of the testicular tissue. This tissue is then examined under the microscope by the Embryologist for the presence of sperm cells. The sample is then processed and used for ICSI or frozen for later use. TESE is a minor theatre procedure carried out on an outpatient basis under general anaesthesia. A Testicular biopsy is also performed in the same manner and sent to the laboratory for analysis as to the possible cause of the problem.
MICRO-TESE or M-TESE (Microsurgical Testicular sperm extraction)
Microsurgical Testicular sperm extraction is a surgical sperm retrieval procedure in which an incision is given in the Testis and an advanced operating micro-dissecting microscope is used to identify the Seminiferous tubules in the Testis which will most probably have sperm. The tissue is then extracted by the Surgeon and the sample is examined under the microscope by the Embryologist for the presence of sperm cells. The sample is then processed and used for ICSI.
Micro-TESE is usually done when TESE has failed to retrieve sperm. It is a minor theatre procedure and can be carried out on an outpatient basis under general anaesthesia.
Why choose one method over another?
Each technique has its advantages and disadvantages. Depending on the cause of absent/low/poor sperm production, the fertility consultant will advise which method is best for you.
For further information/doubts, please contact us.