The usual way of producing sperm for use in ART is manual stimulation and ejaculation. But men with no sperm cells in their ejaculate (azoospermia) need to have sperm surgically retrieved from the testis or epididymis.
This procedure is completely different from a diagnostic testicular biopsy, for the goal is not to identify the state of the testis but to find and harvest sperm.
Apart from azoospermia, surgical sperm retrieval is a typical option for couples where the male partner has undergone vasectomy and has no viable sperm in his ejaculate.
Patients diagnosed with azoospermia may be interested whether this condition can be cured. As is often the case, treatment options (and if there are any to pick up) depend on a specific case particularities. Members of our medical team have a range of alternatives to treat your condition.
Sometimes surgical intervention requires a simple aspiration for men who have a blockage; in other cases, it involves more extensive sampling of the testis for men with a more pronounced sperm production problem. The combination of factors leads to a substantive difference in the amount of time it takes, the need for anesthesia and the equipment used.
One significant factor is if the man is diagnosed with obstructive or non-obstructive azoospermia.
In obstructive azoospermia, some sort of a blockage occurs in the sperm delivery channels, thus sperm is unable to travel outside to the ejaculate. A sperm sample can be typically obtained through surgical extraction if obstructive azoospermia takes place.
In case of non-obstructive azoospermia, problems in sperm production may ensue from genetic disorders or birth defects. Consequently, it is less likely to obtain viable sperm for fertilization.
Procedures and recommendations
PESA (percutaneous epididymal sperm aspiration)
PESA is performed when a sperm sample is needed to carry out IVF/ICSI and is opted for in cases of obstructive azoospermia resulting from either a prior vasectomy or infection. It is done under local anesthesia in the operating room or office and involves extracting sperm with a fine needle from the epididymis or testes.
TESA (Testicular Sperm Aspiration) & TESE (Testicular Sperm Extraction)
Both procedures are applied when the epididymis does not contain any sperm due to impaired sperm production.
TESA is done with local anesthesia in the operating room or office and involves a needle being inserted in the testicle to aspire fluid and tissue with negative pressure.
TESE involves making a small incision in the testis to examine the tubules for the presence of sperm. This procedure is typically (but not every time) performed in the operating room with sedation.
MESA (micro-epididymal sperm aspiration)
MESA is a type of surgery applicable for men who have vasal or epididymal obstruction. It represents the most invasive of the surgical sperm retrieval techniques. MESA is performed in the operating room under general anesthesia using the operating microscope. The procedure involves the cutting open of the scrotum to extract sperm and closing the wound with dissolvable stitches.
In comparison with aspiration techniques, MESA allows for an extensive collection of mature sperm.