Surgical Sperm Retrieval
Testis Sperm Retrieval
There are many ways to get sperm from the reproductive tract. The goal is to get the best quality and number of sperm. Care is taken not to harm the reproductive tract. This will allow future sperm retrieval or reconstruction if needed.
Some of these procedures are:
Testicular Sperm Extraction (TESE)
TESE is often used to diagnose the cause of azoospermia. It can also get enough tissue for sperm extraction. The sperm can be used fresh or frozen (“cryopreserved”). TESE is often done in the urologist's office with a nerve block. A nerve block is an anesthetic injected into nerves to treat pain. The nerve block will "turn off" a pain signal from a specific location; in this case, from the testis. Or, TESE can be done under anesthesia in a surgical center. It involves one or several small cuts in the testes.
Testicular Sperm Aspiration (TESA)
TESA is also sometimes called Testicular Fine Needle Aspiration (TFNA). TESA can be used to diagnose or treat azoospermia. It can also be used to collect sperm from the testicles. It's often done with a nerve block in the Urologist's office or the operating room. A thin needle punctures the skin and testis to gently pull out sperm. No other cuts are needed.
TESA with Mapping
This is where TESA is done with many needle aspirations spread throughout the testes. Aspiration is a medical procedure used to remove tissue samples. Some physicians feel this method is comparable to TESE at recovering sperm. TESA is sometimes used for patients with non-obstructive azoospermia.
Microsurgical Epididymal Sperm Aspiration (MESA)
MESA uses a surgical microscope to help retrieve sperm from the epididymis tubes. MESA can retrieve lots of healthy sperm that can be saved and frozen for later. This method is very safe. However, it calls for general anesthesia and a highly skilled micro-surgeon.
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA, like TESA, can be done many times at a low cost and without a surgical cut and is especially suited for obstructive azoospermia. It doesn't need a high-powered microscope, so more urologists can do it. PESA is done under local or general anesthesia. The urologist sticks a needle attached to a syringe into the epididymis to gently remove the fluid. Sperm may not always come out this way. Sometimes a surgical process is needed.
Microsurgical Testicular Sperm Extraction (Micro-TESE)
Micro-TESE is done only for non-obstructive azoospermia. The outer cover of the testicle is opened and the inside is checked. Your urologist can see areas more likely to be making sperm. This technique is done by a Urologist trained in microsurgery. Micro-TESE is usually done in the operating room. This way, more of the testis is examined, but less tissue is removed. There's also less damage to the blood vessels. Some feel Micro-TESE offers a better chance of finding sperm in the patient with non-obstructive azoospermia.
After Treatment
Recovery after testicular or epididymal sperm retrieval depends on the method used. Recovery time can range from a few days to a week.
Most men will be told to avoid strenuous activity. You might use a jockstrap until you’ve fully recovered. Ice packs help right after the surgery. Your urologist will prescribe medicine to help with the pain. You may also be given antibiotics to take before and/or after sperm retrieval to lower the risk of infection. If you have stitches, you will need more time to heal. Most men can return to office work in 24 to 48 hours. It may take 5 to 10 days to return to heavy work.
Possible problems can include:
Bleeding
Infection
Pain
The chance of not finding sperm
The need for future procedures
Testicular injury or loss (these are rare)
Frequently Asked Questions
How long does sperm retrieval take?
Retrieval time depends on:
The cause of the azoospermia
The technique used
How soon sperm are found
The procedure can take anywhere from minutes to hours.
How much does a sperm retrieval cost?
The cost of sperm retrieval depends on a number of things. Some of these are:
Type of procedure
Where the procedure is done (office or operating room)
How long the procedure takes
Whether sperm are being used fresh or will be frozen for later use
Procedures done in the office under local anesthesia avoid surgical center or anesthesia costs.
What happens if no sperm are found?
It's rare to not find any sperm in cases of obstructive azoospermia.
With non-obstructive azoospermia, sperm may not be retrieved in 20% to 80% of cases. This depends on what caused the non-obstructive azoospermia.
There's always a chance that no sperm will be found. This can be emotionally draining for you and your partner. Couples should discuss this possibility with each other and their doctors before the procedure.
One option is to use donor sperm as a backup for IVF/ICSI. The decision to use donor sperm is very personal. Couples should talk about it and prepare for it before surgery. If using donor sperm isn't an option and no sperm is retrieved, you may think about adopting a child.