Surgical Sperm Retrieval
About 1% of men have no sperm in the ejaculate (Azoospermia). This could be due to either obstruction of the tube (vas deferens) the sperm travel down to become part of the ejaculate (obstructive azoospermia) or testicular failure which is a problem of sperm production by the testis (non-obstructive azoospermia). Some men have congenital absence of the vas deferens such as men who have cystic fibrosis.
Genital examination and blood tests should be done to differentiate between obstructive and non-obstructive azoospermia.
Surgical Sperm Retrieval (SSR) can be done to retrieve sperm from the testis and/or the tube at the back of the testicles that stores and carries sperm (Epididymis). This procedure is called PESA (Percutaneous Epididymal Sperm Aspiration) / TESA (Testicular Sperm Aspiration). PESA/TESA can be done under local anaesthesia or intravenous sedation. During PESA, a fine needle is inserted into the epididymis and collect sperm using a gentle suction. TESA involves inserting a small needle connected to a syringe to retrieve sperm directly from the testis.
Another technique for SSR is called MESA (Microsurgical Epididymal Sperm Aspiration) and MicroTESE (Testicular Sperm Extraction). This is a more invasive procedure that is done under general anaesthesia. It involves making a small incision in the scrotum to take biopsies from the epididymis and testis under microscopic visualisation and close the skin using dissolvable stitches. This is required when PESA/TESA is unsuccessful and for men who have non-obstructive azoospermia.
Sperm retrieved through SSR will be frozen and later on thawed on the day of egg collection to fertilise the collected eggs.