Surgical Sperm Retrieval

Surgical sperm retrieval may be recommended as a treatment option for men who have been diagnosed with Azoospermia (Nil sperm count). That is, men who want to have children and have very little or no sperm present in their ejaculated semen, but the hormone test is normal. In these cases, sperm can be removed directly from the testes using a tiny needle.  The reasons for no sperms found in the ejaculate may be due to:

1. An obstruction caused by any previous injury or infection that prevents the release of the sperm

• A Congenital absence of the vas deferens that is men who are born without the tube that drains the sperm from the testicle
• Men who have had Vasectomy or male sterilisation, which is a surgical procedure to cut or seal the tubes that carry the sperm. It is done to prevent pregnancy.
• In cases of Non-obstructive azoospermia when the testicles are producing very low numbers of sperms which cannot reach the vas deferens. 
  
  Males diagnosed with Azoospermia can be a father of a child through ICSI (Intra cytoplasmic sperm injection) provided the sperm is retrieved surgically from the testes or epididymis. The different procedures through which sperm can be retrieved are discussed below:

1. TESA (Testicular Sperm Aspiration) - It is a procedure performed for men who experience very low sperm count. It is done under sedation in an operating room. A needle is inserted in the testes, and fluid and tissue are aspirated with negative pressure. The aspirated tissue is then processed in the embryology laboratory and the sperm cells extracted are used for ICSI. TESA is often performed for men with obstructive azoospermia.

2. TESE (Testicular Sperm Extraction) - In this procedure, a small portion of tissue is taken by biopsy from the testicle under local anaesthesia, and then, the few viable sperm cells that are present in that tissue are extracted for intracytoplasmic sperm injection (ICSI). TESE is a breakthrough because the sperm does not have to “mature” and pass through the epididymis to fertilise an egg. The testicular sperm extraction process is recommended for men who cannot produce sperm by ejaculation due to azoospermia, which may be caused by primary testicular failure, congenital absence of the vas deferens or non-reconstructed vasectomy. These two procedures, i.e. Intracytoplasmic sperm injection (ICSI) and testicular sperm extraction (TESE) have reduced the need for donor sperm.

3. PESA (Percutaneous Epididymal Sperm Aspiration) – It is a simple procedure whereby the sperms are extracted directly from the epididymis with the help of a syringe. After mild sedation, a small needle is inserted through the skin of the scrotum to collect sperm from the epididymis over the testes, where sperm are usually stored after production. The sperm may be retrieved by delicate suction. This method is typically used if the male is not able to produce any sperm during ejaculation (discharge). The reason for the absence of sperm may be because of blockage or the result of prior surgery.

4. MICRO-TESE (Microsurgical TESE) – It is a surgical procedure used to find sperm in men with non-obstructive azoospermia or extreme testicular disappointment. Micro-TESE is particularly useful in these men, as there might be exceptionally limited territories of sperm creation that might be missed during needle biopsies. This includes an operation performed under general anaesthesia through a small midline entry point in the scrotum, through which one or both testicles can be seen. The specialist looks at the testicle(s) under the magnifying instrument for healthy areas of seminiferous tubules. The operation field is magnified 25 times to look for the limited sperms. The surgeon extracts these tissues which are analysed and processed in the ART laboratory for the presence of sperms.