WHAT ARE THE TECHNIQUES OF SURGICAL SPERM RETRIEVAL?

During fertility investigations, you would have provided a sperm sample to assess the number of sperm you are producing and also how active (motility) and normal (morphology) they look. Unfortunately for some men, this sample will contain no sperm (azoospermia).

You may be referred to an Andrologist for a more detailed assessment and to discuss treatment options. These might include an operation to try to find sperm from inside the testis (surgical sperm retrieval) or epididymis through the following techniques.

Sperm from the epididymis can be retrieved by:

1. Microsurgical (MESA)
2. Percutaneous (PESA) epididymal sperm aspiration

Techniques for sperm retrieval from the testes include:

1. Testicular sperm aspiration (TESA)
2. Testicular sperm extraction (TESE)
3. Microsurgical TESE (micro-TESE)
4. MESA (Microsurgical Epididymal Sperm Aspiration)

Microsurgical (MESA)

This procedure requires general anesthesia. A cut is made in the scrotum to find the testis and epididymis. The surgeon uses an operating microscope to identify the tubules of the epididymis precisely to enable sperm extraction through a fine needle. The fluid is then examined for the presence of healthy sperm.

 PESA (Percutaneous Epididymal Sperm Aspiration)

The surgeon will examine you to identify the epididymis before inserting a small needle directly into the epididymis and aspirating any fluid. An embryologist (sperm scientist) will examine the fluid under a microscope in the procedure room to see if any sperm is present. There may be several attempts on each side to find enough sperm for treatment or to decide that another type of procedure may be more suitable.

Micro-TESE (Microdissection Testicular Sperm Extraction)

This requires general anesthesia. A cut is made in the scrotum to find the testis. The testis is opened and by using an operating microscope, some of the fine individual sperm-producing tubes are removed for detailed assessment. The tissue will be examined in the operating theatre to look for the presence of sperm.

What will happen after the procedure?

1. Since the procedure is done under general anesthesia, it usually takes 2-3 hours to recover and be discharged home.
2. Simple analgesia should be enough after the procedure e.g. paracetamol/ibuprofen.
3. Tight-fitting underwear is recommended to provide scrotal support.
4. Minor discomfort and a little bruising should be expected. If you are experiencing anything more than this or there is significant swelling then you should seek medical advice. There is a very small risk of a hematoma (collection of blood) or infection developing, which may need medical attention.
5. You will either find out on the day that it has been successful or will receive a phone call, usually within 48 hours of the outcome: a. For those who have sperm frozen, a follow-up appointment with the fertility team will be organized to discuss the next step. b. For those for whom sperm has not been found, a follow-up appointment will be organized with a fertility consultant to discuss alternative options.

WHAT STEPS CAN I TAKE TO MAXIMISE CHANCES OF BETTER RESULTS?

You should make sure that your lifestyle is as healthy as possible to maximize your chances of success

• Stop smoking completely
• Make sure you have normal body weight for your height
• Reduce your alcohol intake
• Consider taking a multivitamin tablet containing zinc and selenium
• Do not use any street drugs or gym performance drugs (steroids).

 You should bear in mind any lifestyle changes you make will take more than three months (the life cycle of sperm) to have any effect on sperm production

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