Surgical Sperm Retrieval

What is surgical sperm retrieval?

Surgical sperm retrieval is a broad term used to describe several types of procedures that can be used to recover sperm directly from the testicles when there is no sperm present in the ejaculate, or what is present is not suitable for fertility treatment. When there is no sperm in the ejaculate, this is called azoospermia. Occasionally, there may be sperm in the ejaculate, but the labs tell the clinicians that what is there is not suitable for injecting into eggs because for example, none of the sperm are moving or are alive.

What is involved in a surgical sperm retrieval?

In some cases, we are able to surgically retrieve sperm by performing the following procedures which are performed under local anaesthetic:

  • 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 material collected will be examined and you will be advised about the quality and whether there are any sperm present. Material with sperm will be frozen and placed in storage for use at a later stage. These specimens are then thawed and used to inject the eggs obtained during IVF treatment using the technique of ICSI. If surgical retrieval of sperm is successful, usually enough sperm is obtained for several cycles of treatment (if required). 

MicroTESE (Microsurgical Testicular Sperm Extraction)

If PESA and TESE procedures fail, or not enough sperm is retrieved, the alternative option is a MicroTESE which is performed under general anaesthesia.

The testicles are exposed via a cut in the scrotum and the testicles then opened and the tissue inside the testicles examined under an operating microscope. The areas that are most likely to yield sperm are selectively taken, leaving the other areas behind. It is therefore a more targeted procedure than open biopsies and the total amount of tissue may be less. This procedure does take more time than the biopsy procedures. The testicle and scrotum are then closed with stitches that will dissolve after a time.

Who is suitable for a surgical sperm retrieval procedure?

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)
  • Vasectomy

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 deferens . 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.  The operating microscope magnify tissues by up to 20 times so that the best tubules can be selectively taken.  One of the main advantages is less damage to the testosterone producing cells in the testis. These three conditions carry a success rate of recovering sperm of approximately 80-90%.

  • Vasectomy

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. This is available as self-funded treatment with success rates up to 85%.  However, success rates drop as time from the vasectomy increase and drops to less than 70% success rate after 14 years. 

  • Non-obstructive azoospermia - the testicles are producing such low numbers of sperm that they don't reach the vas deferens (the duct which conveys sperm from the testicle to the urethra)

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. This is done by performing multiple testicular biopsies 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 40-60%. If we are successful at retrieving sperm the pregnancy rate for this treatment is very similar to that of ICSI with ejaculated sperm. 

Surgical Sperm Retrieval at Ramsay Health Care UK

Here at Ramsay Health Care, our skilled and experienced surgeons regularly perform surgical sperm retrieval procedures.  

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