Surgical sperm retrieval

1% of men suffer from azoospermia (a condition diagnosed when there is no sperm in the ejaculate) and will require sperm to be surgically retrieved for use in a cycle of ICSI to allow a chance of successful conception.

Azoospermia can be divided into either "obstructive" or "non-obstructive".

• In obstructive azoospermia there is an obstruction as a likely consequence of either an absent or blocked tube connecting the testicle to the penis (vas deferens), for example following a vasectomy or in some men who are carriers of a defective cystic fibrosis gene. In these men there is virtually a 100% chance of successfully finding sperm surgically.
• Non-obstructive azoospermia is more rare and a more severe form of male infertility. Your consultant will discuss your fertility options with you.

Patients of the Lister Fertility Clinic who need surgery will be treated in conjunction with one of our consultant urologist colleagues.

Sperm can be retrieved from two areas:

1. The epididymis (the structure next to the testicle where sperm are stored and mature prior to ejaculation)

• PESA (Percutaneous epididymal sperm aspiration): The simplest procedure, performed under local anaesthetic where sperm is aspirated using a fine needle and syringe
• MESA (Microsurgical epididymal sperm aspiration): This procedure requires a general anaesthetic to allow direct microscopic visualisation of the epididymis for sperm aspiration. This is required when PESA is not possible or successful and may also allow an attempt to surgically correct any obstruction.

2. The testicle

• Micro-TESE (Testicular sperm extraction): This more invasive procedure is required in those where epididymal retrieval has failed or with a non-obstructive cause of azoospermia. Under general anesthetic, small biopsies are taken directly from the testicle under microscopic visualization which is then examined to find small numbers of sperm that can be used for treatment.

The retrieval may be planned in advance and the sperm frozen, or on occasion timed to coincide with ovarian stimulation with a urologist on stand-by on the day of egg collection.

Although frozen sperm has been shown to be as effective as fresh, in some with a non-obstructive cause where minimal sperm numbers may be retrieved, there may be a concern that insufficient quantities would survive the freeze / thaw process.

The final decision on the type and timing of the retrieval will be made by your urologist in conjunction with your Lister Fertility Clinic consultant.