Surgical Sperm Retrieval
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in Fertility Care
Surgical sperm retrieval refers to a group of medical techniques where sperm is collected directly from a man’s reproductive tissues like the testis or epididymis using specialized procedures.
Surgical Sperm Retrieval
What is Surgical Sperm Retrieval ?
Surgical sperm retrieval refers to a group of medical techniques where sperm is collected directly from a man’s reproductive tissues like the testis or epididymis using specialized procedures. This is done when there are no sperm in the ejaculate (a condition known as azoospermia) or when ejaculation isn’t possible. Retrieved sperm is used in IVF with ICSI (Intracytoplasmic Sperm Injection), enabling fertilization even when natural sperm release fails.
When It is Considered ?
Surgical retrieval is recommended when:
- A man has obstructive azoospermia (a blockage preventing sperm release such as a vasectomy or congenital issue).
- A man has non-obstructive azoospermia (reduced or no sperm production, though some may still exist in the testes).
- Ejaculation is not possible (due to physical or psychological reasons).
- Sperm retrieved is needed for ICSI to facilitate fertilization.
Types of Procedures
Here are the main surgical sperm retrieval methods commonly used today:
Step 1 : PESA (Percutaneous Epididymal Sperm Aspiration)
- ,What it is: A needle is inserted through the scrotal skin into the epididymis to aspirate sperm-containing fluid
- Best for: Obstructive azoospermia (e.g., after vasectomy).
- Anesthesia: Usually local.
Step 2 : MESA (Microsurgical Epididymal Sperm Aspiration)
- What it is: A small surgical incision plus an operating microscope is used to access and precisely extract sperm from epididymal tubules
- Best for: Cases needing a large volume of mature sperm, such as congenital absences or obstructions.
- Anesthesia: Usually local.
Step 3 : TESA (Testicular Sperm Aspiration)
- What it is: A needle aspirates tissue and fluid directly from the testis.
- Best for: Both obstructive and non-obstructive azoospermia with expected sperm production.
- Anesthesia: Local.
Step 4 : TESE (Testicular Sperm Extraction)
- What it is: A minor surgical biopsy of testicular tissue to search for sperm.
- Best for: Cases where prior aspiration fails or in non-obstructive azoospermia.
- Anesthesia: Local or general.
Step 5 : Micro-TESE (Microsurgical TESE)
- What it is: An advanced version of TESE using operating microscopes to pinpoint small areas of the testis likely to contain sperm.
- Best for: Severe non-obstructive azoospermia
- Anesthesia: General. Minimizes testicular tissue removal, improving success rates.
Procedure Overview
- Pre-operative evaluations like semen analyses, hormonal testing, imaging (scrotal ultrasound), and genetic tests are performed.
- The chosen procedure is performed—typically under local or general anesthesia—timed, if possible, with egg retrieval from the partner.
- Retrieved tissue or fluid is assessed immediately in the lab; viable sperm is used fresh for ICSI or cryopreserved for future use.
