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Surgical Sperm Retrieval
What is Surgical Sperm Retrieval (SSR)?
Surgical Sperm Retrieval is a treatment option for men who have no sperm in their ejaculate (azoospermia). Sperm cells are retrieved directly from the testicle or epididymis by means of a small surgical procedure. Although only a small number of sperm is obtained, it is usually sufficient for IVF with ICSI as only one sperm is required for each egg. Before the introduction of this technique, the only treatment option for the infertile couples is using donor sperm.
Who might benefit from Surgical Sperm Retrieval?
Sperm cells produced in the testes are transported to the epididymis, where they mature and are stored. For male with azoospermia, a trial procedure is usually performed before the female partner undergoes the IVF treatment to ensure that the sperm can be found and stored for future fertility treatment.
How is Surgical Sperm Retrieval performed?
(1) Percutaneous Epididymal Sperm Aspiration (PESA)/Testicular Sperm Aspiration (TESA)
PESA – A fine needle is passed directly into the head of the epididymis through the scrotal skin and the fluid is aspirated and examined for the presence of sperm.
TESA – A needle is inserted in the testicles and a tiny amount of tissue is aspirated from the seminiferous tubules which is then processed in the laboratory and checked for the presence of sperm.
These surgical procedures can be done with local anaesthesia.
(2) Microscopic Epididymal Sperm Aspiration (MESA)/ Testicular Sperm Extraction (TESE)
MESA – An incision is made through the scrotum and into the epididymis. Epididymis is examined under the operating microscope. Small amount of fluid is then sucked and examined for the presence of sperm.
TESE – Tissue is removed from the testicle through a small incision and examined under microscope in the laboratory to find sperm cells.
These procedures can be performed with local anaesthesia or general anaesthesia.
Can sperm always be retrieved by Surgical Sperm Retrieval?
It can be difficult to know whether the men can produce sperm or not until the surgical procedure is performed. However, not all patients are suitable for this surgical procedure and it may not be able to retrieve any viable sperm.
What happens if sperm is obtained?
If sperm is found in the trial biopsy, the sample will be examined by the embryologist to assess their suitability for treatment. If the quality of the sample is good it will be frozen and stored for future fertility treatment. If the sperm is not feasible for freezing, the procedure will be performed again on the day of egg collection.
What happens if sperm is not obtained?
If no sperm is found in PESA/TESA, then MESA/TESE may be considered. If still no sperm can be found, then IVF with ICSI is impossible and sperm donation, adoption or accept childlessness will be the alternative options.
Are there any risks with Surgical Sperm Retrieval?
In general, Surgical Sperm Retrieval is a safe operation. Possible complications include bleeding, bruising, haematoma formation and infection.
What happens on the day of the Surgical Sperm Retrieval and what should and shouldn't do after the procedure?
You should not have anything to eat or drink for 4 hours before the procedure. After the procedure you will return to your ward for observation. Local anaesthesia is generally considered safe for sperm retrieval but some patients may experience allergic reactions to the medication. In addition, possible mild side effects related to local anaesthesia may also occur such as nausea, vomiting and cardiac arrhythmia, etc.
Possible mild side effects related to general anaesthesia include tiredness, dizziness, malaise, headache, nausea and vomiting. You may also be a little drowsy from the sedative. For your safety, you should be accompanied home. The residual effects of these medications may impair your functioning. You should not consume alcohol, climb, drive, operate machinery or sign legal documents for at least 24 hours. If you feel really unwell or have any symptoms of hypoventilation, airway obstruction, cardiac arrhythmia or loss of consciousness, please go to the Accident & Emergency Department of Prince of Wales Hospital or any nearest hospital and inform the doctor of your recent treatment.
You may experience some mild discomfort following the procedure, which should be relieved by simple painkillers. You are advised to wear some supportive underwear and loose trousers until the discomfort is settled.
An appointment will be given for follow up before discharge.