Surgical sperm retrieval refers to a group of procedures designed to help overcome certain causes of fertility challenges in men. These techniques are based on extracting sperm directly from the body rather than from ejaculate.
Surgical sperm retrieval techniques are considered for couples who are having difficulties conceiving due to azoospermia (when no sperm is present in the male partner’s ejaculate).
  Azoospermia can be caused by:
On occasion, sperm retrieval may also be used for couples affected by sperm DNA fragmentation where other treatments have been unsuccessful. High levels of DNA damage in a sperm cell can lead to infertility, including increased miscarriage rates.
The goal of sperm retrieval is to obtain enough healthy, viable sperm from the testes or epididymis (tubes connected to each testicle that store sperm, among other functions) to perform an ICSI cycle. We aim to do this with minimal disruption to the surrounding tissues so that your normal testicular function can be preserved as much as possible.
Also known as testicular biopsy, TESE can be used for both obstructive and non-obstructive causes of azoospermia but is more frequently used for non-obstructive causes. A small incision is made in the testicle under general anesthesia, and a tiny amount of tissue is biopsied to look for the presence of sperm. Healthy sperm can then be used fresh for an ICSI cycle or frozen for future cycles. Â
MicroTESE is similar to the conventional TESE procedure but with greater precision in selecting the location of tissue sampling. The testicle is opened with an incision so an operating microscope can be used to identify which tubules are most likely to contain sperm, which significantly increases the success rates compared to TESE. This approach also minimises unnecessary tissue damage and reduces the risk of complications. MicroTESE is usually only used for non-obstructive azoospermia.
TESA can be used to retrieve sperm from men with obstructive azoospermia. Under general anaesthesia, a fine needle is inserted through the scrotal skin into the testicle several times. A tiny amount of testicular tissue (the tubules) is suctioned into a syringe each time and transferred to the laboratory to assess for the presence of sperm.Â
I take a methodical and thorough approach to investigating all causes of your fertility challenges. If surgical sperm retrieval combined with IVF and/or ICSI will give you the best chance of success, we’ll discuss everything you need to know to feel confident in moving forward with treatment and achieving your parenthood goals. Â
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Certain sperm retrieval techniques are associated with a higher likelihood of obtaining healthy sperm compared to others in certain situations, but we can never promise a live birth from retrieved sperm as many other variables will affect success. Dr Marren will select the most appropriate surgical technique based on your circumstances, such as whether you are experiencing obstructive or non-obstructive azoospermia.
TESE, microTESE, and TESA are not considered high-risk operations but as with all surgical procedures, do come with a risk of complications. The main risks include bleeding, infection, or unintentional injury and loss of testicular function. On occasion, no sperm is found with the initial aspiration procedure and you may need to undergo a more invasive biopsy. These procedures may also be associated with a potential decrease in testosterone production, which takes some time to return to normal.
The amount of time you need to take off from work will depend on which surgical technique is used and the typical activities involved in your occupation. If your role is mainly sedentary (e.g. desk work) and you had an aspiration procedure such as TESA, you may feel comfortable returning to work the next day. More invasive procedures, such as microTESE or TESE may require up to a week or more of rest.
It can be distressing for men and their partners if surgical sperm retrieval yields no results. The possibility of this will be discussed with you prior to the procedure. In the case of obstructive azoospermia, it is highly likely that we can retrieve some sperm, however, up to 80% of retrieval procedures for non-obstructive azoospermia may result in no sperm. Dr Marren can discuss your options with using donor sperm in this situation.
