Department of Urology

Surgical Sperm Retrieval

Overview

Azoospermia is the complete absence of sperm in the ejaculate.  It may result from obstruction of the genital ducts (like in the case of vasectomy) or from poor/absent production of sperm in the testicles.  Even in cases where no sperm are found in the ejaculate, sperm may be retrieved from the testicle using minimally invasive techniques.  Once sperm is retrieved, pregnancy is possible with the use of intracytoplasmic sperm injection (ICSI).  The type of procedure used to retrieve sperm will depend upon the reason for azoospermia.  Importantly, not all men will have sperm found in the testes, regardless of the surgical technique used.

Description

The following techniques may be used to retrieve sperm from the male reproductive tract.  The most appropriate technique for you should selected after consultation with Dr. Walsh and the conclusion of specific diagnostic tests if needed.  In most circumstances, retrieved sperm will be cryopreserved for future use of Assisted Reproductive Technology.

TESA – Testicular Sperm Aspiration:  This procedure is generally performed with local anesthetic and is a clinic based procedure.  After one or both of the testes are numbed, a needle is used to aspirate sperm containing testicular tissue. Sperm are assessed by an andrologist and cryopreserved using appropriate techniques.  The best candidates for TESA are men in whom we are confident that sperm are being produced in adequate quantities throughout the testicles.  No incisions are needed for this procedure.

TESE – Testicular Sperm Extraction.  Similar to TESA, TESE is performed with a local anesthetic in most circumstances, but requires a small incision to expose the testicular tissue.  This procedure may be used diagnostically to confirm the presence of sperm.  It may also be used for men in whom we are confident that sperm are being produced,  but who are not good candidates for a percutaneous procedure due to  prior surgery or scar within the testis.

microTESE – Microscopic Testicular Sperm Extraction allows for the most comprehensive exploration to identify viable sperm within the testes.  Because of the potentially long duration of the operation, it may be performed with a general anesthetic.  MicroTESE requires a larger incision to expose the entire contents of both testicles.  Usinga  high powered magnification provided by a surgical microscope, Dr. Walsh will “leaf through” all seminiferous tubules in an effort to find rare sperm. This technique requires dedicated laboratory resources to examine tissue samples while the surgery is performed.  This technique is best for men with non-obstructive azoospermia , those with sparse sperm on FNA mapping, or for any man who desires the most definitive sperm retrieval procedure despite the maximally invasive nature.

PESA – Percutaneous Epididymal Sperm Aspiration:  Nearly identical to TESA, this procedure retrieves from epididymis which are more mature and may have better survivability after cryopreservation.  This procedure is generally reserved for men with obstructive azoospermia (prior vasectomy) who prefer the most minimally invasive approach.

MESA – Microscopic Epdidymal Sperm Aspiration:  With this procedure sperm are retrieved by direct exposure of a single epididymal tubule using  high magnification provided by a surgical microscope.  Although this procedure does require an incision, it general allows the highest quantity of  sperm to be retrieved.

Preoperative Considerations

Unfortunately, infertility treatment in the United States is not uniformly covered by health insurance plans.  While some plans may provide for tests and procedures related to the diagnosis of male infertility, many will not provide for surgical retrieval of sperm.  Because of this, it is essential that patients considering sperm retrieval consult their own health insurance policy.   In some cases, you may be required to pay for the sperm retrieval procedure in advance of it being performed.  Sperm cryopreservation is an additional cost for both initial preservation and maintenance of the specimen.  These latter fees are generally billed separately.

Postoperative Care

All of the procedures are generally well tolerated and have relatively rapid recovery. 

Immediately after the procedure:

  1. Remove all dressings from inside the athletic supporter in 24 hours; continue with the scrotal support for 3 days total. You may shower once the dressings are removed.
  2. Apply frequent ice packs to the scrotum the night of surgery and the day after. After 24 hours, discontinue the ice. You can apply moist heat (a warm bath) to the scrotum after 5 days.
  3. Prescribed pain medication can be taken as directed. Two to three days after surgery, Extra-Strength Tylenol or Ibuprofen (Advil, Motrin) should be sufficient for pain relief. These are over-the-counter medications.
  4. If an incision is made, it will be closed with absorbable sutures. They do not need to be removed. It may take up to two or three weeks for sutures to dissolve completely.
  5. Resume a normal, well-balanced diet when you return home. Start with easily digested foods such as soups and broths if you have any stomach upset from an anesthetic. Be sure to include lots of fluids.
  6. Normal, non-vigorous activity can be restarted after 48 hours or when you feel better. Activities that cause discomfort should be stopped for the time being. Heavy activities such as jogging and weight lifting can be resumed in 1 week. You may return to work when comfortable.
  7. Refrain from sexual intercourse for 4 days.
  8. You may experience discomfort after the procedure. Common discomforts or symptoms include the following and do not require a doctor’s attention:
        1. Bruising and discoloration of the scrotal skin and base of penis. This will take one week to go away.
        2. A small degree of scrotal swelling.
        3. A small amount of thin, clear, pinkish fluid may drain from the incision for a few days after surgery. Keep the area clean and dry.
        4. If you received general anesthesia, a sore throat, nausea, constipation, and general “body ache” may occur. These problems should resolve within 48 hours.
  9. Postoperative complications are rare. If the following occur, you should seek prompt medical attention.