This can be performed in situations where there is not sperm in the ejaculate that is suitable for fertility treatment. The type of procedure that is offered will depend on the underlying reason for the problem and the aim is to recover sperm from the testicles that is suitable for Sperm injection (ICSI).
PESA (percutaneous epididymal sperm aspiration)
This procedure is used in situations where it is believed that the reason for the lack of sperm in the ejaculate is due to a blockage, such as in a man who has had a vasectomy. In this procedure, after local anaesthetic is injected into the scrotum to numb it, a small needle is inserted through the skin of the scrotum into the cap at the top of the testicle, called the epididymis, which may well be swollen with sperm-containing fluid. The fluid is drawn off and examined under a microscope. The quality of the sperm can only be assessed once it has been retrieved. Sometimes it can be frozen to avoid repeat procedures being required.
If no sperm is retrieved from the epididymis then a biopsy of one or both testes may be necessary. In this case after more local anaesthetic is administered, a small cut is made in the scrotal skin and in the surface of the testis. This is so a small amount of tissue can be removed and sperm extracted from it by the lab team. Sometimes a small portion of the tissue may be sent for laboratory assessment of its structure and the sperm production process. The cuts in the testes and the scrotal skin are then closed with small stitches. These stitches will dissolve and don’t need to be removed.
Microsurgical Epididymal Sperm Aspiration and multisite Testicular Biopsies (MESA and multisite TESE)
This procedure is also used in situations where the reason for the lack of sperm in the ejaculate is thought to be due to a blockage. The cause for this isn’t clear. This procedure is carried out as a day case at the Royal Victoria Infirmary under general anaesthesia. The testicles are exposed via a cut in the scrotum and fluid in the epididymis drawn off with a cap. This is done using an operating microscope to give a better view. A scientist examines the fluid to check for moving sperm and if none is seen, the surgeon then takes a few biopsies from each testicle through small cuts. The cuts and scrotal skin are then closed with stitches that dissolve. The fluid/biopsies containing sperm are taken to Newcastle Fertility Centre for analysis and storage.
Microsurgical Testicular Sperm Extraction (MicroTESE)
This procedure is used in situations where the reason for the lack of sperm in the ejaculate is due to a production type problem. In such cases, there may be small areas of sperm – production occurring in the testicle, but this is not certain. This procedure is carried out as a day case at the Royal Victoria Infirmary under general anaesthesia. After exposing the testicles through a cut in the scrotum, the testicles are opened and the contents examined under an operating microscope.
The most promising areas are taken to Newcastle Fertility Centre where fertility scientists examine it for sperm that is suitable for ICSI. The cuts in the testicles and the scrotal skin are then closed with stitches that dissolve. As sperm in these situations is less likely to survive storage well, the female partner usually has IVF treatment alongside the operation. This is so her eggs can be recovered and fresh sperm injected into them (ICSI) if possible.
As there is a higher chance that sperm may not be recovered, some couples choose to have donor sperm to be available as a back-up, in case it is needed. This option will be discussed with you and appropriate counselling given before you make your decision. It may not be a treatment option you would want to take up. The use of donor sperm as a back-up must be arranged well in advance of treatment.
All individuals storing either embryos or gametes must now be screened for HIV, Hepatitis B and Hepatitis C. We are currently unable to process fluid and tissue from patients with these conditions and they cannot therefore undergo surgical sperm retrieval.