Surgical sperm retrieval can be performed in situations where there is not sperm in the ejaculate that is suitable for fertility treatment. The type of procedure that is offered will depend on the underlying reason for the problem and the aim is to recover sperm from the testicles that is suitable for sperm injection (ICSI).
PESA (percutaneous epididymal sperm aspiration)
This procedure is used in situations where it is believed that the reason for the lack of sperm in the ejaculate is due to a blockage, such as in a man who has had a vasectomy. This procedure is done with local anaesthetic injected into the scrotum to numb it, a small needle is inserted through the skin of the scrotum into the cap at the top of the testicle, called the epididymis, which may well be swollen with sperm-containing fluid. The fluid is drawn off and examined under a microscope. The quality of the sperm can only be assessed once it has been retrieved. Sometimes it can be frozen to avoid repeat procedures being required.
Testicular biopsy
If no sperm is retrieved from the epididymis then a biopsy of one or both testes may be necessary. In this case you require general anaesthetic, a small cut is made in the scrotal skin and in the surface of the testis. This is so a small amount of tissue can be removed and sperm extracted from it by the lab team. Sometimes a small portion of the tissue may be sent for laboratory assessment of its structure and the sperm production process. The cuts in the testes and the scrotal skin are then closed with small stitches. These stitches will dissolve and don’t need to be removed.