What is Azoospermia?
Azoospermia is diagnosed when no sperm can be found in the ejaculate. This can occur when:
- sperm are produced in testicle but are blocked from being transported into the ejaculate (Obstructive Azoospermia), or
- sperm production in the testicle is severely impaired even when there is no obstruction to transport of sperm (Non-obstructive Azoospermia).
In either situation, it may be possible to obtain sperm by performing extraction of spermatozoa directly from the testicle or epididymis through microsurgery.
What is Surgical Sperm Retrieval?
Surgical Sperm Retrieval involves the collection of sperm directly from the testicle or epididymis through the performance of microsurgical techniques. The testicle and/or epididymis is exposed and access to the seminiferous tubules within the testicle or the tubules of the epididymis is gained. Sperm may be collected by incision of tubules and aspiration or by excision of the tubules. The aspirates or excised tubules are examined in the laboratory to identify spermatozoa.
Reproart Georgian-American Center for Reproductive Medicine – Surgical Sperm Retrieval Procedure
Surgical Sperm Retrieval May be Recommended to:
- Males with azoospermia (when the ejaculate does not contain spermatozoa);
- Males with ejaculation problems;
- Males with total asthenozoospermia/necrozoospermia (when all spermatozoa in the ejaculate are immotile);
- Males with a high degree of DNA fragmentation in their ejaculated sperm;
- Males with vasectomy in the past (male sterilization).
Surgical Sperm Retrieval Methods
Spermatozoa extracted through sperm aspiration or excision are used for In-Vitro Fertilization with Intracytoplasmic Sperm Injection (ICSI) to enable the couple to have a biological child.
The male infertility specialist decides whether surgical sperm retrieval should be performed based on the following tests: semen analysis (spermogram), hormonal analyses, physical examination and reproductive gland ultrasound. Microsurgery is a brief procedure with intravenous anesthesia.
Sperm aspiration uses different microsurgery methods:
- PESA: percutaneous epididymal sperm aspiration
- MESA: microsurgical epididymal sperm aspiration
- MESE: microsurgical epididymal sperm extraction
- TeSA: testicular sperm aspiration
- TeSE: testicular sperm extraction
- Micro TeSE: microsurgical testicular sperm extraction
Reproart and its highly qualified personnel conduct successful surgeries on the testicle and its epididymis that lies on the surface of the testicle.
65% of the sperm retrievals at Reproart result in spermatozoa exhibiting some level of motility (often just shaking). Any motion of the sperm is considered an indication that the sperm is alive.
Fertilization using surgically retrieved sperm is always assisted by using ICSI. ICSI is required because sperm gain the ability to fertilize egg without assistance only during their transit through the vas deferens. Sperm obtained during surgical sperm retrievals that exhibit some motility are quite competent to fertilize eggs with ICSI assistance and result in normal, developing embryos.
Of course, if no sperm are found the couple may need to use sperm from a donor.
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Frequently Asked Questions (FAQs)
We know that fertility care often brings up many questions — and that every journey is different. Below you’ll find answers to some of the most common questions our patients ask.
Can the retrieved sperm be frozen?
Yes. Even if only a small number of viable sperm are retrieved, they can be cryopreserved (frozen) for future use in IVF with ICSI. Therefore, one sperm retrieval may provide enough sperm for several egg retrievals if more than one retrieval is necessary to achieve your goals for family-building.
How is Micro TeSE different from other sperm retrieval methods?
Micro TeSE is a microsurgical technique performed under a high-powered operating microscope. Unlike other methods (such as TESA or TESE), it allows the surgeon to visually identify areas with active sperm production, leading to higher success rates with minimal tissue removal. Micro TESE is described in a separate section Micro TESE (Microsurgical Testicular Sperm Extraction).
Can sperm be retrieved more than once?
Yes, in many cases sperm retrieval can be repeated, especially if both testicles are expected to have sperm and the first procedure used only one testicle. However, this depends on the condition of the testicular tissue, previous outcomes, and overall health. Cryopreserving sperm during the first successful procedure is often recommended to avoid repeat surgery.
