In cases of male infertility, where there is little or no sperm in the semen discharge, sperm retrieval is an advanced microsurgical method used to retrieve sperm. Sperm retrieval for IVF is a painless treatment that has been shown to be efficient in retrieving viable sperm for in vitro fertilization.
Fertility specialists will identify the most appropriate type of sperm retrieval based on the male partner's sperm analysis and a comprehensive physical assessment. Sperm is taken directly from either the epididymis or the testicles. Because epididymal sperm responds better to cryopreservation, retrieval from the epididymis is preferred whenever possible (freezing). The following are the most typical types of Sperm retrieval for IVF:
Men who are having sperm collected for IVF/ICSI will undergo the TESA treatment. TESA sperm retrieval is performed under local anaesthesia in the operating room or office. It is timed to coincide with the egg retrieval of their female spouse. The testicle is pierced with a needle, and tissue and sperm are extracted. Men with obstructive azoospermia (s/p vasectomy) undergo TESA. When TESA fails to provide adequate tissue/sperm, an open testicular biopsy is required.
PESA is a treatment used to recover sperm for IVF/ICSI in men who have obstructive azoospermia due to a previous vasectomy or infection. PESA sperm retrieval is performed under local anaesthesia in the operating room or office, and it is timed to coincide with the egg retrieval of their female spouse.
TESE requires making a small slit in the testis and screening for sperm in the tubules. It is either performed on a scheduled basis or in conjunction with the egg retrieval of their female spouse. TESE sperm retrieval is normally done under anaesthesia in the surgery room, however, it can also be done in the office with only local anaesthesia. During this technique, patients commonly cryopreserve sperm for future IVF/ICSI.
Non-surgical Sperm Retrieval
If you have anejaculation or retrograde ejaculation, ejaculation can be induced. Then the semen is collected.
Two methods are:
Penile Vibratory Stimulation (PVS)
PVS is done with a special vibrator placed at the tip of the penis. This stimulation can cause an ejaculation.
Electroejaculation (EEJ)
EEJ is done with a probe that sends electrical energy to the prostate and seminal vesicle. EEJ may be done in the urologist's office for men with nerve injuries and no feeling. But for men who have normal sensation, general anesthesia is needed. General anesthesia is used to prevent pain during this EEJ procedure. It makes you unconscious. You do not feel any pain, and you do not remember the procedure afterwards. If PVS or EEJ don't work, a sperm retrieval method from the epididymis or testicle may be needed.
Testis Sperm Retrieval
There are many ways to get sperm from the reproductive tract. The goal is to get the best quality and number of sperm. Care is taken not to harm the reproductive tract. This will allow future sperm retrieval or reconstruction, if needed.
Some of these procedures are:
Testicular Sperm Extraction (TESE)
TESE is often used to diagnose the cause of azoospermia. It can also get enough tissue for sperm extraction. The sperm can be used fresh or frozen (“cryopreserved”). TESE is often done in the urologist's office with a nerve block. A nerve block is an anesthetic injected into nerves to treat pain. The nerve block will "turn off" a pain signal from a specific location; in this case, from the testis. Or, TESE can be done under anesthesia in a surgical center. It involves one or several small cuts in the testes.
Testicular Sperm Aspiration (TESA)
TESA is also sometimes called Testicular Fine Needle Aspiration (TFNA). TESA can be used to diagnose or treat azoospermia. It can also be used to collect sperm from the testicles. It's often done with a nerve block in the Urologist's office or the operating room. A thin needle punctures the skin and testis to gently pull out sperm. No other cuts are needed.
TESA with Mapping
This is where TESA is done with many needle aspirations spread throughout the testes. Aspiration is a medical procedure used to remove tissue samples. Some physicians feel this method is comparable to TESE at recovering sperm. TESA is sometimes used for patients with non- obstructive azoospermia.
Microsurgical Epididymal Sperm Aspiration (MESA)
MESA uses a surgical microscope to help retrieve sperm from the epididymis tubes. MESA can retrieve lots of healthy sperm that can be saved and frozen for later. This method is very safe. However, it calls for general anesthesia and a highly skilled micro-surgeon. Percutaneous Epididymal Sperm Aspiration (PESA) PESA, like TESA, can be done many times at low cost and without a surgical cut and is especially suited for obstructive azoospermia. It doesn't need a high-powered microscope, so more urologists can do it. PESA is done under local or general anesthesia. The urologist sticks a needle attached to a syringe into the epididymis to gently remove fluid. Sperm may not always come out this way. Sometimes a surgical process is needed.
Microsurgical Testicular Sperm Extraction (Micro-TESE)
Micro-TESE is done only for non-obstructive azoospermia. The outer cover of the testicle is opened and the inside is checked. Your urologist can see areas more likely to be making sperm. This technique is done by a Urologist trained in microsurgery. Micro-TESE is usually done in the operating room. This way, more of the testis is examined, but less tissue is removed. There's also less damage to the blood vessels. Some feel Micro-TESE offers a better chance of finding sperm in the patient with non-obstructive azoospermia.
Recovery after testicular or epididymal sperm retrieval depends on the method used. Recovery time can range from a few days to a week. Most men will be told to avoid strenuous activity. You might use a jockstrap until you’ve fully recovered. Ice packs help right after the surgery. Your urologist will prescribe medicine to help with pain. You may also be given antibiotics to take before and/or after sperm retrieval to lower the risk of infection. If you have stitches, you will need more time to heal. Most men can return to office work in 24 to 48 hours. It may take 5 to 10 days to return to heavy work.
Possible problems can include:
The timing of sperm retrieval for IVF in relation to the in vitro fertilisation cycle is a complicated issue. Harvesting the sperm ahead of time and freezing it until the eggs are extracted helps the couple to make an informed decision about whether or not to pursue IVF, as the chances of finding sperm are usually just 60% or less.
After being washed and further processed in the IVF lab, the retrieved sperm are injected directly into the partner's eggs via intracytoplasmic sperm injection (ICSI), and the IVF cycle continues normally. Many couples suffering from male factor infertility have had success with IVF through sperm retrieval for IVF techniques. High pregnancy rates have emerged from the refining of microsurgical procedures paired with advances in cryopreservation technologies.