In the process of trying to conceive, some men may discover that they do not have enough sperm in their ejaculate or may have a blockage of their vas, which may be due to a prior vasectomy or a condition since birth.
To support the process of conception, a sperm retrieval procedure may be necessary to remove tissue from their testicles to support pregnancy through in-vitro fertilization (IVF). IVF is the process where eggs are removed from the female partner; eggs and sperm are combined outside the body to create embryos and embryos are inserted back into the female partner.
After a sperm retrieval procedure, your results would be sent to the andrology lab, who specializes in sperm and sperm hormones, to evaluate the tissue extracted and confirm the presence of sperm and the quantity.
If sperm retrieval is deemed necessary, there are a variety of potential procedures depending on your situation.
TESE (Testicular sperm extraction)
In this procedure, your testicle will be numbed using a local anesthetic. While numb, your physician will create a small incision in your scrotum and testicle to remove tissue. The incision is smaller than a dime and the procedure takes about 30 minutes.
TESA (Testicular sperm aspiration)
In this procedure, your testicle will be numbed using a local anesthetic. While using a very small needle, your physician will insert a syringe and a larger needle to extract tissue. No incision is made during this procedure. The procedure takes about 30 minutes.
PESA (Percutaneous epididymal sperm aspiration)
This procedure is similar to the TESA. Your physician will access the epididymis (tubes on the back of the testicle) with a smaller needle to remove sperm fluid. The procedure takes about 30 minutes.
This helps us determine:
- Is there sperm present in the testicles
- How much sperm is present
- Where is sperm present
This procedure allows our team to plan for your IVF cycle with the highest chances of pregnancy conception with the least amount of risk to you and your partner. A 2nd procedure is required to retrieve the sperm either ahead of or at the time of your IVF cycle.
Micro-TESE (Microsurgical testicular sperm extraction
For some men with no presence of sperm in their ejaculate, a detailed evaluation of their testicles is done under a high-powered operative surgical microscope. In this surgery, the testicles are opened fully and systematically evaluated from top-to-bottom and side-to-side in search of plump tubes filled with sperm.
These tubes often have very small amounts of sperm and may be used with IVF/ICSI (in-vitro fertilization / intracytoplasmic sperm injection). This surgery takes 2-3 hours under general anesthesia and is the most detailed evaluation possible of your testicles. This procedure requires a fellowship-trained surgical specialist to perform the surgery.