Surgical Sperm Retrieval
Surgical sperm retrieval is used when sperm are absent or present in extremely low numbers in the ejaculate but sperm production may still be occurring within the testicles or epididymis. Retrieved sperm can be used for in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI).
The appropriate technique depends primarily on whether the patient has obstructive azoospermia, in which sperm production is occurring normally but sperm cannot reach the ejaculate, or non-obstructive azoospermia, in which sperm production itself is severely impaired.
Types of Surgical Sperm Retrieval
TESE — Testicular Sperm Extraction
TESE involves making a small opening in the scrotum and removing a small amount of testicular tissue for examination by the embryology laboratory. Sperm can often be identified immediately and either used for IVF/ICSI or cryopreserved.
TESE is particularly useful for men with obstructive azoospermia and selected men with impaired sperm production. In obstructive azoospermia, sperm retrieval rates are generally very high, often approaching 100% when sperm production is intact.
The procedure is usually performed as an outpatient procedure under local anesthesia with sedation or general anesthesia depending on the circumstances. Most men experience mild-to-moderate scrotal discomfort and swelling for several days and can return to routine activities relatively quickly.
Potential risks include bleeding, infection, temporary pain or swelling, and injury to testicular tissue. Because the amount of tissue removed is relatively small, significant effects on testosterone production are uncommon, although risks vary depending on the underlying testicular function and extent of surgery.
MicroTESE — Microsurgical Testicular Sperm Extraction
MicroTESE is an advanced form of testicular sperm retrieval designed primarily for men with non-obstructive azoospermia (NOA), in whom sperm production is severely impaired.
Using an operating microscope, the testicle is opened and individual areas suspicious for sperm-producing seminiferous tubules are carefully identified and removed for examination by the embryology laboratory. This allows a more targeted search for sperm while minimizing unnecessary removal of testicular tissue.
MicroTESE provides the highest likelihood of sperm retrieval for many men with non-obstructive azoospermia, although success depends heavily on the underlying cause of azoospermia. Overall sperm retrieval rates are commonly approximately 40–60%, with substantial variation based on the patient's diagnosis, genetics, hormones, and prior treatment.
Recovery generally involves several days of scrotal discomfort and swelling, with avoidance of strenuous activity for approximately 1–2 weeks. Potential risks include bleeding, infection, testicular discomfort, and a potential decline in testosterone production. MicroTESE is designed to minimize testicular injury compared with more extensive conventional tissue removal.
MESA — Microsurgical Epididymal Sperm Aspiration
MESA is a microsurgical technique used primarily for men with obstructive azoospermia, in whom sperm production is normal but sperm cannot reach the ejaculate because of an obstruction such as prior vasectomy or congenital absence of the vas deferens.
Using an operating microscope, fluid containing sperm is carefully collected directly from the epididymis. Because men with obstructive azoospermia generally produce sperm normally, large numbers of sperm can often be obtained and cryopreserved for future IVF/ICSI cycles.
MESA is performed as an outpatient procedure and generally has a relatively quick recovery. The major risks include bleeding, infection, and injury to the epididymis or testicle, although significant complications are uncommon.