Sperm Retrieval
Sperm retrieval is reserved for the most severe cases of male infertility. The most common reason for sperm retrieval is when men have no sperm in their ejaculate (azoospermia). This can be due to a blockage in the plumbing (ex. Vasectomy) when the “sperm factory” or testicle is producing healthy amounts of sperm. This is “Obstructive Azoospermia.” The other situation is when the plumbing is wide open but sperm production is not occurring properly. This is “Non-Obstructive Azoospermia.” The success rates of sperm retrieval mostly depend on how well sperm are being produced.
Sperm Retrieval with ICSI, not IUI
Sperm retrieval with Intracytoplasmic Sperm Injection (the most commonly used form of In Vitro Fertilization) may be the treatment of choice or the only treatment available to certain couples. It is important to clarify that sperm retrieval is not used in conjunction with Intrauterine Inseminations (IUI). Sperm retrieval does not yield the millions of sperm that are needed for an IUI. Sperm retrieval focuses on getting enough sperm so that a single sperm can be chosen to be injected into a single egg to make an embryo.
What Types of Sperm Retrieval Are There?
A quick review of a man’s anatomy reminds us that behind the testicle (“sperm factory”) is the epididymis. This structure acts as a “refinery” where last minute touch-ups and adjustments are made to the sperm. Sperm can be retrieved from either the testicle or the epididymis depending on his reproductive capacity.
There are five main ways of retrieving sperm that each have their own peculiar acronyms:
- MESA: MicroEpididymal Sperm Aspiration
- PESA: Percutaneous Epididymal Sperm Aspiration
- TESA: Testicular Sperm Aspiration
- TESE: Testicular Sperm Extraction
- Micro-TESE: Microsurgical Testicular Sperm Extraction
An aspiration is when tiny catheters are used to gently “suck” up sperm when they are in in the pipes of the epididymis or back in the testicular sperm factory. An extraction is when a small incision is make in the scrotum. A window is then opened over the testicle so that tiny pieces of sperm-producing tissue can be retrieved (each is the size of kernel of rice).
Which Option is Best for Us? ↑↓
Having so many options is great because “one size does not fit all.” A comprehensive male fertility evaluation and a careful discussion with you and your partner will determine which option is the safest and the most efficient way to locate and retrieve sperm for you. Each option has its advantages and disadvantages:
Option |
Advantages |
Disadvantages |
MESA* |
↓ Blood contamination Lots of sperm back/↑ Retrieval rates ↓ Risk of hematoma Best pregnancy rates |
Requires microsurgery expertise ↑ Cost General anesthesia Requires scrotal exploration ↑ Post-operative discomfort |
PESA  |
No microsurgery expertise required Local or general anesthesia Few instruments required Fast/Repeatable Minimal post-operative discomfort ↓ Cost |
Feasiblility depends on anatomy Less sperm back Blood contamination ↑ Risk of hematoma Damage to adjacent tissues |
TESA  |
No microsurgery expertise required Local or general anesthesia Few instruments required Fast/Repeatable Minimal post-operative discomfort ↓ Cost |
Less sperm back Blood contamination ↑ Risk of hematoma Risk of testicular damage/atrophy |
TESE  |
No microsurgery expertise required Local or general anesthesia Few instruments required Fast/Repeatable |
If non-obstructive azoospermia, Then less sperm back. Risk of testicular damage/atrophy Scrotal exploration required |
Micro-TESE* |
Few instruments required Best for Non-Obstructive Azoospermia |
Microsurgical expertise required. General anesthesia Not fast/Time consuming Scrotal exploration required ↑↑↑ Cost ↑↑ Risk of testicular damage ↑↑ Post-operative discomfort Minimally repeatable |
* Requires microsurgical expertise with fellowship-training preferable. |
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As you can see, a lot of factors go into choosing the best option. At the Southwest Fertility Center for Men specializes in offering you all of these options. This is made possible by Dr. Kuang’s microsurgical expertise that opens up all these options for you.