CRGW Ltd: 07029220
Surgical Sperm Retrieval
An uncommon type of male infertility (1-2%) occurs when there are no sperm in the semen
(azoospermia). In half these cases sperm production in the testicles is normal but there is a
blockage, which prevents the sperm from entering the semen (obstructive azoospermia). This
may be due to failure of the sperm passages to develop (congenital absence of the vas deferens),
blockage of the tubes (epididymis, vas deferens) transporting sperm or a previous vasectomy
(male sterilisation) operation.
Surgical sperm retrieval techniques are now available whereby sperm from men with obstructive
azoospermia can be removed from the epididymis or even the testicle and then used to fertilise
eggs using ICSI.
Sperm Retrieval
There are 3 main methods of surgically retrieving sperm:
1. Microepidydimal Sperm Aspiration (MESA)
This technique is performed under general anaesthetic and requires an overnight stay in hospital.
A small incision is made in the scrotum to permit access to the epididymis and the testicle. Using
an operating microscope a tiny cut is made into the epididymis and the fluid within is removed and
examined to see if there are any sperm present.
If sufficient sperm cells are found they can be frozen for subsequent use in a future IVF/ICSI
cycle.
2. Percutaneous Epidydimal Sperm Aspiration (PESA)
The advantage of this technique is that it can be performed without surgical scrotal exploration. A
small needle is passed into the epididymis and fluid is removed. This procedure can be carried out
under sedation enabling you to return home the same day.
3. Testicular Sperm Extraction/Aspiration (TESE/TESA)
If sperm is not found in the fluid taken from the epididymis via either the MESA or PESA
procedure a small sample of testicular tissue can be taken. This is then examined back at the
laboratory, sperm can be extracted and either frozen or used fresh for ICSI.
There is usually a little bruising and tenderness in the scrotum for 24-48 hours after the operation.
You will usually be back to full activity within 3-5 days. Dissolving stitches are used and healing is
usually complete by 10-14 days. All surgical procedures carry a small risk because of the
anaesthesia and there may be some bleeding or a possibility of wound infection.
Document Name: PI 34 Surgical Sperm Retrieval
Approved By: Amanda O’Leary
Author: Lyndon Miles
Version 1 (March 2010)
Page 1 of 4
CRGW Ltd: 07029220
Advantages
MESA
o
o
o
o
PESA
o
o
o
o
o
o
TESE/
TESA
o
o
Disadvantages
One study has shown fertilization
rates of 78% and pregnancy
rates of 67%.
Samples
are
routinely
subsequently frozen so can be
used for a number of ICSI cycles.
Obtain sperm from men with
irreparable epididymal obstructive
problems.
A higher concentration of sperm
may be yielded via MESA than
PESA, however no difference in
fertilization rates or pregnancy
rates have been shown.
o
One
study
has
shown
fertilization rates of 82% and
pregnancy rates of 73%.
Cost less than MESA.
Less invasive – less time in
hospital.
Less risk of infection.
Less scarring.
Can be carried out the day
before oocyte recovery and
incubated overnight to be used
fresh for ICSI, the surplus
sample can then be frozen for
future use.
Provides a method of sperm
retrieval if no sperm is found in
the epididymis.
There is no difference in clinical
pregnancy rate between fresh
and frozen testicular samples.
o
o
o
o
o
o
o
o
o
o
o
o
o
Document Name: PI 34 Surgical Sperm Retrieval
Approved By: Amanda O’Leary
Author: Lyndon Miles
General anaesthetic required –
increased period in hospital.
More invasive than PESA therefore
increased risk of pain etc following the
procedure.
More expensive than PESA.
Higher risk of infection from open
surgery
Possible failure to obtain sperm.
Sometime sperm does not survive
the freezing and thawing process very
well and therefore a fresh sperm
retrieval may be necessary on the day.
May not be successful for
irreparable epididymal obstruction.
No sperm may be found and female
partner
may
have
undergone
superovulation.
Some discomfort may be felt during
the procedure as done under local
anaesthetic and sedation.
Potential
risk
of
temporary or
permanent injury to testicles due to
open biopsy.
Risk of testicular pain and atrophy.
Decreased number of sperm usually
retrieved than via MESA or PESA
Lower fertilization rate and pregnancy
rates than with epidiymal sperm
After initial extraction sperm motility is
usually decreased, incubation for 24-48
hours can increase motility prior to
freezing or ICSI.
Version 1 (March 2010)
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CRGW Ltd: 07029220
Consents
A consent form requesting the above techniques must be signed before commencing a surgical
sperm collection.
Preparing for Surgical Sperm Retrieval
Before coming to CRGW, the patient should remove the hair from the scrotum by shaving.
He should bring a tight pair of ‘slip’-style underpants or swimming trunks – not boxer shorts - with
him.
He will need to be accompanied by a driver or to arrange a lift / taxi as he will not be able to drive
for 24 hours after the procedure.
As with any surgical procedure, there is a slight risk of bleeding, bruising or infection. In order to
reduce this risk he is advised to wear a tightly fitting pair of underpants for 24 hours (including
overnight) after the procedure.
After The Procedure
For the few days after we advise:
 no drugs containing aspirin
 no hot baths
 no strenuous exercise
When discharged from CRGW you will receive a summary letter giving details of the procedure
and the contact details of the Medical Director.
If he is concerned or feel particularly unwell, call us on 01443 443999
The Female Partner’s Treatment
Ovarian stimulation and egg collection is carried out a usually few weeks after the surgical sperm
retrieval procedure or the day after if a fresh sample is to be used. The eggs are fertilised by ICSI
whereby a single sperm is injected into the egg. Once fertilised, the embryos are allowed to
develop for 2-3 days and then transferred to the womb.
Cystic Fibrosis Screening in Congenital Absence of the Vas Deferens
Two thirds of men with absent vas deferens are carriers of the recessive gene for cystic fibrosis
(CF), an illness leading to severe respiratory problems for infants. It is advised that the men have
a test for the CF gene before a MESA is carried out. If found to be positive, it is recommended
that the female partner has her CF status checked as well. If your partner is also found to be
positive for this gene we recommend full Genetic Counselling and discussion prior to considering
treatment.
Surgical sperm retrieval procedures do not guarantee that sperm will be found. Survival of
any sperm that is retrieved during the procedure after freezing and thawing also cannot be
guaranteed.
Document Name: PI 34 Surgical Sperm Retrieval
Approved By: Amanda O’Leary
Author: Lyndon Miles
Version 1 (March 2010)
Page 3 of 4
CRGW Ltd: 07029220
Alternatives to Surgical Sperm Retrieval
As an alternative to surgical sperm retrieval donor sperm can be used for insemination. However
there is currently a national shortage of donor sperm within the UK. Please see PI 2.1 for
information on donor insemination.
Y Chromosome Screening in Patients with Azoospermia
In some patients who do not have some sperm in their ejaculate the cause may be due to micro
deletion of part of their Y chromosome. If sperm from such a patient is used to achieve a
pregnancy any male child will carry the same deletion.
References:
Lin YM, Hsu CC, Kuo TC, Lin JS, Wang ST, Huang KE (2000). Journal of the Formosan medical
association. Percutaneous epididymal sperm aspiration versus microsurgical epidydimal sperm
aspiration for irreparable obstructive azoospermia - experience with 100 cases.
Rosenlund B, Westlander G, Wood M, Lundin K, Reismer E, Hillensjo T (1998). Human
Reproduction 13 2805-07. Sperm Retrieval and fertilization in repeated percutaneous epididymal
sperm aspiration.
Pasqualotto F, Rossi-Ferragut L, Rocha C, Iaconelli A, Borges E (2002). Journal of Urology 167
1753-1756. Outcome of in vitro fertilization and intracytoplasmic injection of epididymal and
testicular sperm obtained from patients with obstructive and non obstructive azoospermia.
Kwan H, Chow V, Clark A. University of British Columbia, Vancouver, Canada.
Document Name: PI 34 Surgical Sperm Retrieval
Approved By: Amanda O’Leary
Author: Lyndon Miles
Version 1 (March 2010)
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