Surgical Sperm Retrieval From the Male Reproductive Tract

Sperm retrieval is any way used to get sperm for fertility purposes. There are many ways to get sperm. The method used depends on why sperm aren't in the semen, what the patient wants, and the surgeon's skill.
The information here should help you and your partner talk with your urologist.

Sperm retrieval is done when pregnancy is the goal but not possible without help. It is for men who have little or no sperm in the semen, or men who aren't able to ejaculate. In these cases, sperm can be collected from other parts of the reproductive tract. For good pregnancy rates, sperm retrieval is used with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

In vitro fertilization (IVF) is the process of combining an egg and sperm in a laboratory dish for fertilization. This combined sperm and egg are called an embryo. The embryo is transferred to the uterus for development.

Intracytoplasmic sperm injection (ICSI) is an IVF process where a single sperm is injected directly into an egg.

The way to check for sperm in the semen is to do a semen analysis. Your urologist will look at your semen under a microscope. No sperm in the semen (“azoospermia”) may mean sperm retrieval is needed.

The 2 main types of azoospermia are obstructive azoospermia and non-obstructive azoospermia.

OBSTRUCTİVE AZOOSPERMİA

With this condition, the testicles make sperm but a block in the male’s reproductive tract stops them from getting into semen. (This is how a vasectomy works. It is surgery to block the sperm from getting into semen.) Sometimes there may be no vas deferens because of a birth defect. This can happen if you have the gene that causes cystic fibrosis. There might also be blocks in the epididymis and ejaculatory duct. Or, the vas deferens may have damage from a hernia repair or other surgery. Obstructive azoospermia may be surgically correctable.

NON-OBSTRUCTİVE AZOOSPERMİA

With this condition, your body might not make sperm at all. Or the sperm might be made in such low levels that there aren’t enough of them to appear in the ejaculate. Blood hormone tests and genetic tests can help find the cause.
Some men have orgasms but no semen comes out of the penis. An orgasm is the physical experience that happens because of sexual stimulation. Ejaculation (release of semen) may occur when you reach orgasm. You may also have muscle contractions, an increased heart rate, breathing rate, blood pressure and sweating. Lack of visible semen with sexual stimulation may be due to anejaculation (lack of ejaculation) or retrograde ejaculation:
Anejaculation is when no seminal fluid reaches the urethra.
Retrograde ejaculation is when semen gets into the urethra but flows the wrong way. Instead of going out through the penis, the semen is pushed back into the bladder. This doesn’t hurt the body, but it can cause infertility.

Anejaculation or retrograde ejaculation can be caused by injuries, medical or surgical conditions. Some of these are:
Spinal cord injury
Advanced diabetes
Multiple sclerosis
Psychological issues
Pelvic surgery
Your urologist can diagnose these conditions by checking your urine for sperm after an orgasm. If healthy sperm can’t be released naturally, sperm retrieval may be needed.

TESTİS SPERM RETRİEVAL

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:

TESTİCULAR SPERM EXTRACTİON (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.

TESTİCULAR SPERM ASPİRATİON (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 WİTH MAPPİNG

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.

MİCROSURGİCAL EPİDİDYMAL SPERM ASPİRATİON (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 EPİDİDYMAL SPERM ASPİRATİON (PESA)

PESA, like TESA, can be done many times at 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 fluid. Sperm may not always come out this way. Sometimes a surgical process is needed.

MİCROSURGİCAL TESTİCULAR SPERM EXTRACTİON (MİCRO-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.
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 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)