What is surgical sperm retrieval?
Surgical sperm retrieval is the process of retrieving the sperm; so it can used to fertilise an egg or be frozen for future use. Sperm retrieved from either the testicles - where sperm is produced or the epididymis - where sperm is stored.
To know more read this article: WHAT ARE THE TECHNIQUES OF SURGICAL SPERM RETRIEVAL?
When will surgical sperm retrieval be required?
The procedure is usually only needed for the following reasons:
The male partner is producing no sperm in his ejaculate, a condition known as azoospermia
The male partner is impotent and cannot produce ejaculate
What does process involve?
Normally a fine needle will be inserted into the epididymis, which is located next to the testis and some fluid is withdrawn for analysis. This procedure is known as Percutaneous Epididymal Sperm Aspiration or PESA or Micro Epididymal Sperm Aspiration (MESA).
If either of these procedures do not retrieve sperm then a second procedure can be attempted, Testicular Sperm Extraction (TeSE) whereby a biopsy (a small piece of tissue) is taken from the testis for close analysis under a microscope. Dependent on the case, this may require open or closed surgery to retrieve the biopsy and Mr Julian Norman-Taylor will discuss the operation with you in detail, focusing on the procedure that is likely to produce the best results for you.
How long is sperm retrieval surgery?
The procedure takes about 20-30 minutes. If the aspirates fail to show any viable sperm then the surgeon will proceed to the other options (TESE), usually on another day.
Which sperm retrieval procedure is recommended?
There are numerous ways to harvest sperm from a man with normal sperm production and a blockage. TESA is the simplest and most cost-effective is an aspiration of sperm.
Why would I need to have sperm removed surgically?
Men with Azoospermia do not have any sperm in their ejaculate. Forty percent of azoospermia cases are due to a blockage (obstruction) in the reproductive tract. Problems with sperm production account for the rest.
Depending on the cause, a man with azoospermia may still be able to father a child. A man with an obstruction may be able to have sperm retrieved with special surgical techniques. In vitro fertilization (IVF) is often needed to achieve pregnancy for these cases. Sperm retrieval may also be possible for men who have problems with sperm production.
Are other tests needed before extraction?
A fertility evaluation of the man should be done along with the evaluation of the female partner. If the semen analysis shows you have no sperm (azoospermia) or very few sperm (severe oligozoospermia), you should have a complete history, physical exam, and possibly laboratory testing. Sometimes a testicular biopsy is needed. This procedure takes a small piece of tissue from the testicle and can show whether azoospermia is due to a blockage or a problem producing sperm. A urologist that specializes in reproductive medicine and surgery can recommend the sperm retrieval method that is best for your particular situation.
Once sperm is retrieved, is it used right away?
Your urologist may coordinate the sperm retrieval surgery with your partner’s reproductive specialist so fresh sperm can be used or sperm can be frozen and used later. When IVF is also done, surgically retrieved sperm will be injected directly into an egg in a process called intracytoplasmic sperm injection (ICSI).
Is there anyone these treatments aren’t right for?
Yes, these treatments wouldn’t work for men with certain genetic conditions, where the sperm production is completely absent or the gonads have failed to form.
Are there any side effects?
Side effects tend to be rare, but bleeding and infection can occur.
A small number of men experience a drop in their testosterone following surgical sperm retrieval, which may cause problems with sexual function, sleep, muscle weakness and anxiety. If you have any side effects at all, you should contact your clinic straight away.
Men who have fertility problems are also slightly more likely to develop testicular cancer, so it’s very important you check your testicles regularly for lumps.
What should I expect when I first go to the clinic?
Initially you’ll probably just be asked to answer a few questions and your genitals may be examined.
If necessary, you may then be asked at a later date to have some blood tests or produce a sperm sample (if you’re able to).
Are there any risks from using sperm collected in this way?
There is no evidence that sperm collected surgically affects your chances of getting pregnant or that it poses a risk to the health and wellbeing of any children you might conceive.
Research has shown that sperm extracted surgically may not fertilise as well, although this could be due to the fact that some sperm is of lower quality.
What can I do if it doesn’t work?
If you’ve had surgical sperm extraction and it hasn’t been successful, you may want to consider other options for having a family, such as using donor sperm in treatment or adopting.