Surgical Sperm Retrieval

Sperm harvesting as a fertility treatment in men

Among a hundred men, one of them produces no sperm- a generic condition of azoospermia. A variety of techniques exist to cure azoospermia, one of them is the surgical sperm retrieval and ivf, a procedure used for the treatment of male infertility associated with ICSI and IVF treatment.

Male infertility relates to low sperm, poor sperm or no sperm. Surgical sperm retrieval uses several techniques to retrieve sperm called TESA, TESE, MESA, and PESA, which are performed for the collection of sperm via needle aspiration or through surgical sperm removal of tissue.

Recommendation for surgical sperm retrieval

Most of the men produce healthy sperm but due to blockage in testicles it prevents ejaculation, so surgical sperm retrieval is recommended when family planning is the ultimate goal. This is for men; therefore, sperm is gathered from the reproductive tracts. For a positive pregnancy, sperm retrieval is recommended for IVF (in-vitro fertilization) and ICSI (intracytoplasmic sperm injection).

Surgical sperm retrieval is suggested in the following scenarios:

• A patient who refrain themselves from vasectomy.
• Men who had a vasectomy or failed vasectomy reversal.
• Absence of tubes joining epididymis to the penis.
• Men who do not produce quality sperm in their semen.
• History of testicles surgery.
• An illness affecting testicles.
• Spinal injury or issue with normal ejaculatory functions.
• Men with congenital or endocrine conditions.
• Men suffering from Klinefelter syndrome.
• Men under opioids, steroids, and testosterone.

Surgical sperm retrieval techniques

There are different kinds of SSR procedure which shall be implied after determining the causes.

Testicular sperm extraction (TESE): If no sperm is found then a small incision is made to the testis for sampling. TESE in IVF procedure uses a thin needle punctures to the skin and testis with no other cuts. The procedure can cause tenderness and some amount of pain.

 In TESE single biopsy or open scrotal exploration and multifunctional biopsies are performed to examine the sperm mobility and count. TESE fertility treatment helps to diagnose azoospermia. TESE IVF procedure involves collecting sperm from testicles.

The sperm obtained are either of subsequent use or frozen. A single sperm is injected directly into to frozen egg known as ICSI IVF. TESE IVF success is determined only after going through the reports obtained after injecting of sperm in eggs. TESE IVF cost depends on the situation and cases of individual, and the only place to perform TESE in Nepal is Vatsalya.

Micro-epididymal sperm aspiration (MESA): MESA IVF is performed in men who face vasal or epididymal obstruction. Also known as the MESA fertility treatment, the procedure is either done solely or in coordination with the female partner’s egg. MESA in IVF allows an extensive collection of mature sperm and is the most sought method for men who have no vas deferens.  A small cut is made into the epididymis. The fluid is obtained for microscopic observation to figure out viable sperm. Vatsalya is the only MESA clinic in Kathmandu offering high-tech surgical sperm retrieval techniques.

Vasectomy reversal:

The surgery aims to restore fertility. A minor surgery is done to connect the tube to penis.

Percutaneous epididymal sperm aspiration (PESA): A painless procedure seeking for no surgery. A fine needle is inserted into the epididymis from which the fluid is aspirated. The obtained fluid is then inspected to for sperm motility and content. PESA IVF is done under local anesthesia, where a syringe is inserted to gently remove the fluid.

Microdissection TESE (Micro TESE):

This is recommended to men who are facing trouble in sperm production or azoospermia. Micro TESE is carefully coordinated with the female retrieval egg. It is a safer procedure as less testicular tissue is removed.  There is also a less damage to the blood vessels and hence is the better surgical sperm retrieval in finding sperm of the patient with non-obstructive azoospermia.

Process of Surgical Sperm Retrieval

Numerous process is involved to retrieve sperm, the techniques used depends on:

• The method of retrieval or amount of tissue required (aspiration vs biopsy).
• Location of extraction of tissue (vas deferens or testicles or epididymis).
• Procedure method through skin or incision (open vs percutaneous).
• Instruments used (conventional vs microsurgical).

Preparing for Surgical Sperm Retrieval

Before getting admitted to hospital certain criteria should be followed as mandated by the surgeon.  You may also be asked to fast for at least 6-8 hours prior to the procedures. While consuming alcohol is strictly prohibited for at least 24 hours.

Even after surgery, one should avoid alcohol, taking drugs, refrain from strenuous exercise, and sexual activity is not advised for a week of the procedure.

Tests required before Surgical Sperm Retrieval treatment

Before plunging onto surgery further investigation is needed for biopsy as in the later stage it could create problems for the unborn child.  Few of the generic investigation includes:

Hormone tests:

• Testosterone, Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) are measured.
• Very high LH and FSH and low testosterone suggest testicles are not functioning well where the chances of obtaining sperm are extreme lower.
• On this examination, one can identify the vas deferens and absence of congenital.

Chromosome Analysis:

• Abnormalities in the chromosome may prevent the production of sperm.
• It is important to check men chromosomes before the biopsy.

Cystic Fibrosis Testing:

• This issue is carried by men whose vasa deferens is absent.
• If identified in a partner, there are chances of a child being affected.
• If the gene is negative the treatment can continue, if positive, counselling and supports are available in Vatsalya.

HIV and Hepatitis:

• Individuals storing sperm are examined for HIV and Hepatitis B and C.
• This prevents the issues of cross-contamination in the embryo vessel.

Frequently Asked Questions

How long will the surgical sperm retrieval take?

Well, the surgical retrieval time depends on:

• The techniques used.
• Causes of azoospermia.
• Identifying of sperm.

The procedure timing depends in between minutes or hours.

How much will the surgical sperm retrieval cost?

The cost of surgical sperm retrieval depends on several factors such as:

• Types of surgical surgery.
• Surgical centers.
• Procedure period & timing.
• Usage of fresh sperm or frozen sperm.

All the procedures are done under local anesthesia and other tests before surgery tests.

To know more on the Surgical Retrieval cost and treatment in Nepal, contact us!