Surgical sperm retrieval – 10 key facts

01 Mar Surgical sperm retrieval – 10 key facts

Female fertility is a hot topic. So why is male infertility never really talked about? In a fertility industry geared towards women, medical help for men also exists. Obviously. 1 in 50 men produce no sperm in their ejaculate, even though healthy sperm is stored in their testes. Since IVF requires a sperm sample via masturbation, this statistic is relevant. Surgical sperm retrieval (SSR) is an option for men with serious fertility issues. Read on to discover 10 facts you should know about surgical sperm retrieval.

1. SSR – what exactly is it?

Before an IVF cycle, the first step for male partners is to provide a semen analysis. Depending on the results, and in quite rare cases, surgical sperm retrieval may be needed prior to egg retrieval. Some men may have a very low sperm count (azoospermia) or no sperm in their semen. SSR is an impressive technique for collecting sperm directly from a man’s testicles, epididymis or vas deferens. Many men don’t know about it. But it can be a successful solution for male-factor infertility.

2. Obstruction or not?

There are several ways to obtain sperm by medical intervention. The exact method of surgical sperm retrieval depends on why sperm aren’t in the semen. For men who produce no sperm in their ejaculate, there’s a 50% chance it’s due to a blockage in one of the tubes that carry sperm from the testes. When obstruction is the problem, which can occasionally be caused by conditions such as testicular cancer, TESA, PESA, Perc Biopsy or MESA are suitable. These can generally retrieve large numbers of sperm.

If there’s no obstruction and still no sperm, it’s likely there’s a problem with sperm production. A more invasive retrieval method may be needed, such as TESE or Micro-TESE.

3. Surgical sperm retrieval – the full list.

The six main SSR treatments all work a little differently. Here’s a breakdown.

PESA (percutaneous epididymal sperm aspiration). This is perhaps the simplest and least invasive SSR procedure. Sperm is collected through a fine needle directly from the epididymis – the tube connected to the testicle. It’s performed under local anaesthetic). If PESA doesn’t work, then NAB (needle aspiration biopsy) can be tried.

TESE (testicular sperm extraction). If both PESA and NAB fail, this technique can be used. TESE is a more invasive procedure. Biopsies are taken from a larger area of testicular tissue, not the epididymis. These are examined under a microscope to find small numbers of usable sperm. It’s perhaps the most popular surgical sperm retrieval method.

Micro-dissection TESE. This is slowly replacing TESE as a more optimal form of retrieval for men with no sperm in their semen. Very similar to the TESE technique, micro-TESE uses a micro-dissecting microscope to pinpoint the tissue to be removed. Much smaller biopsies are taken. Less damage is caused to the structure inside the testicle.

TESA (testicular sperm aspiration). A needle is inserted in the testicle using a biopsy ‘gun’. This obtains samples of sperm and tissue using gentle suction. These are then carefully dissected under a microscope. Like the other techniques, any sperm found are cultured and/or frozen for future use in an IVF cycle – typically using ICSI.

Percutaneous biopsy. This is similar to TESA, but a different needle is used. It’s sometimes called a fine needle biopsy. A biopsy is taken from the testicular tissue and it usually retrieves a larger number of sperm.

MESA (microsurgical epididymal sperm aspiration). This procedure usually requires a general anaesthetic, as a microscope is used. It’s carried out when PESA is not possible and may also allow an attempt to surgically correct any obstruction. There’s a 70% success rate.

4. Surgical sperm retrieval loves vasectomies.

Many men have a vasectomy as a means of contraception, then later regret it when they want more children. SSR removes sperm surgically. So for men who’ve had a vasectomy, a failed vasectomy or perhaps have no vas deferens, SSR is a godsend. PESA and MESA are often considered the optimal SSR procedures for post-vasectomy patients. The chances of collecting usable sperm are pretty high.

5. SSR is low risk.

Surgical sperm retrieval is a relatively low-risk procedure. But, as with all operations, there can be complications – including bleeding, infection and haematoma (blood clot) in the testicle. There’s also a very small risk of testicular damage and chronic testicular pain.

6. Success rates look promising – so far.

Surprising, the jury is still out on the precise success rates of surgical sperm retrieval. Like so many infertility treatments, large-scale randomised trials are sorely needed. One clinic we spoke to said that men with obstructive azoospermia have a very high chance of recovering sperm via SSR (over 90%). For men with non-obstructive azoospermia, another clinic said the chances of recovering sperm is approximately 40%. If any clinics or practitioners are reading this post, please leave a comment with your stats.

7. Okay – but it is really always needed?

One argument is that surgical sperm retrieval is not necessarily always needed. The American Society of Reproductive Medicine says that SSR has revolutionised the treatment of azoospermia. But because of how easily it is performed it’s now perhaps being over-used. And they say in no way should it be done without counselling first. Like ICSI, SSR has become mainstream. But routine treatments are not always right.

8. It’s all about… price.

Let’s talk money. Surgical sperm retrieval can be pretty costly, with prices ranging from £500 to £3,000. But the average UK price, including a pre-op assessment, seems to be around £1,500. (At the Czech clinic we work with, it’s £500. Enough said.)

9. After all that, it’s over to ICSI.

Once sperm has been successfully retrieved, intracytoplasmic sperm injection (ICSI) can be used to inseminate the collected eggs. Success rates for ICSI, post-SSR, are very similar to those using ICSI and ejaculated sperm. Or to put it another way, once SSR is carried out, the chance of creating viable embryos is very good.

10. Donor sperm as backup? You may need it.

Is surgical sperm retrieval fails, what happens? The short answer is that a sperm donor may be your next option. It’s not for everyone, but if your objective is a baby and a repeat SSR also fails, it may be your only route. You may also have just had your eggs collected, so no back-up means a wasted cycle. The good news? Plenty of clinics abroad, and third-party providers, can help. Don’t assume you need to use a UK sperm donor if you live in the UK. Clinics in mainland Europe far exceed the UK in terms of supply and recruitment of sperm donors. Do your research and you’ll find an option to suit you.