Surgical Sperm Retrieval (TESA and PESA): This is a technique of collecting sperm from the vasdeferens, epididymis or testis. It is a minor procedure done as a day case surgery usually under local anaesthesia. Surgical sperm retrieval is recommended in:
- Men with azoospermia (absence of sperm in the ejaculate) due to a blockage preventing sperm from entering the semen i.e. obstructive azoospermia. Here normal sperm production takes place in the testicles. Blockage is usually at the level of sperm transport tubules (epididymis or vasdeferens e.g. congenital absence of vasdeferens, a previous vasectomy /failed reversal). Blockage could also be due to infection e.g. Chlamydia, gonorrhea or due to previous injury.
- Men with azoospermia due to failure of sperm production by the testicles (non- obstructive azoospermia). Approximately 50% of these men may have sperm producing “islands” in their testicles. This can only be discovered by Testicular biopsy, which may yield some sperm that can be used for ICSI (Intracytoplasmic sperm injection) .
PESA (Percutaneous Sperm Aspiration)
Here, a fine needle is inserted through the scrotum into the epididymis and sperm obtained by gentle suction. After collection, each sample is examined under a microscope to confirm the presence of sperm.
TESA (Testicular Sperm Aspiration)
Here a fine needle is inserted into the testis and tissue samples are obtained by gentle suction and examined under the microscope. If no sperm is present, a small testicular biopsy is taken through a small incision in the scrotum and testis, immature sperm can then be extracted from the tissue. The cut is then stitched back. Surgically retrieved sperm are immature and therefore not capable of fertilization by conventional means except by ICSI. After the procedure a firm scrotal support will be recommended as well as regular pain killers like paracetamol as you may feel some discomfort and bruising for about 48hrs.
If there are spare sperm or testicular tissue, these may be cryopreserved for later use. Surgical sperm retrieval is usually timed to coincide with the female partner’s egg collection so that in case no sperm is found, the couple can decide either to cancel the egg collection and abandon treatment altogether or proceed with egg collection and inseminate with donor sperm if this has been discussed and agreed as a ” back up” measure .