Surgically retrieved sperm are used in an IVF/ICSI treatment cycle to achieve pregnancy.
This can be performed in situations where there is no sperm released naturally and in these cases it isn’t 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).
Surgical sperm retrieval for blockage‑related causes
PESA (percutaneous epididymal sperm aspiration)
This procedure may be recommended when the absence of sperm in a semen sample is thought to be due to a blockage, such as after a vasectomy. A local anaesthetic is used to make the area comfortable, and a fine needle is then used to collect a small sample of fluid from the area above the testicle, where sperm can sometimes build up.
The sample is examined in the laboratory to check whether sperm are present and to assess their quality. If suitable sperm are found, they can sometimes be frozen for future treatment, which may help avoid the need for another procedure.
Testicular biopsy
If no sperm can be collected from the area above the testicle, a testicular biopsy may be recommended. This involves taking a very small sample of tissue directly from one or both testes to look for sperm.
Additional local anaesthetic is used to ensure the area is fully numb. A small opening is made so that a tiny piece of tissue can be removed. The laboratory team then carefully examines this tissue to see whether sperm can be found and used for treatment. In some cases, a small portion of the sample may also be sent for further analysis to understand sperm production more fully.
Once the biopsy is complete, the small openings are closed with dissolvable stitches, which do not need to be removed.
Combined retrieval procedure
Microsurgical Epididymal Sperm Aspiration and Multisite Testicular Biopsies (MESA and multisite TESE)
This combined procedure may be recommended when the absence of sperm in a semen sample is thought to be due to a blockage, although the exact cause is not always clear. It is carried out as a day‑case procedure at the Royal Victoria Infirmary under a general anaesthetic.
During the operation, the surgeon uses a high‑powered operating microscope to carefully collect a small sample of fluid from the area above the testicle, where sperm can sometimes be found. A scientist examines this sample immediately to look for moving sperm.
If sperm are not seen in the fluid, the surgeon will then take a few small tissue samples (biopsies) from different areas of the testicles to increase the chance of finding sperm.
Once the procedure is complete, the small openings are closed with dissolvable stitches, which do not need to be removed. The collected samples are then transferred to the Newcastle Fertility Centre for detailed assessment and, if suitable, storage for future treatment
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.
