Surgical Sperm Retrieval

What is Surgical Sperm Retrieval?

This technique is used to help couples where the male partner does not ejaculate sperm. A small number of sperm are obtained directly from the epididymis or testicles in a small surgical procedure sufficient for IVF treatment.

Who might benefit from Surgical Sperm Retrieval?

Sperm are formed in the testes and stored in the epididymis when mature. Some men produce sperm in the testis but they do not reach the ejaculate.

This can be due to:

• Absence of the vasa deferens (the tubes carrying the sperm)
• Blockage of the vasa deferens (perhaps because of vasectomy)
• Other testicular disorders

In most cases, a trial procedure ensures sperm will be found before IVF treatment enabling us to freeze sperm for later use in some cases.

How is Surgical Sperm Retrieval performed?

Percutaneous Epididymal Sperm Aspiration (PESA);

• The procedure is usually done under sedation with pain relief, but can be done under General Anaesthetic
• In some men, sperm can be extracted directly from the epididymis
• A fine needle is passed through the skin of the scrotum and placed in the epididymis
• Small amounts of fluid can be taken and examined for sperm

Alternatively;

Testicular Sperm Aspiration (TESA);

• Sperm is extracted directly from the testicles by passing a fine needle directly into the testicle
• A small amount of tissue is extracted and prepared in the laboratory and examined for sperm

Sperm obtained are either frozen for subsequent use or prepared using a process of washing and grading. A single sperm is then injected directly into each egg in a process known as intracytoplasmic sperm injection or ICSI.

Are sperm always obtained using Surgical Sperm Retrieval?

Not all patients are suitable for this technique and occasionally, no viable sperm can be recovered.

Sperm can only be obtained if the man’s testicles are producing sperm. Unfortunately, it’s not always possible to predict. Hormone tests and examination can help, but a trial biopsy is the only way to be sure.

What happens if sperm are obtained?

• Sperm found in the trial biopsy can be frozen for use in a subsequent treatment cycle
• If sufficient, suitable sperm can be obtained, treatment can begin
• A test thaw is conducted on a small part of the sample to check sperm can survive the freezing process
• Surviving sperm can be used in subsequent treatment
• If sperm do not survive the thawing process, Dr. Ong will perform a fresh procedure at the same time as egg collection, during treatment.

Generally, PESA sperm can be frozen and thawed in the majority of cases, but TESA sperm does not freeze well.

What happens if sperm are not obtained?

If no sperm are found in the biopsy, IVF with ICSI will not be suitable. We will discuss all your options and alternatives including Donor Insemination in the clinic.

What happens in a PESA/TESA treatment cycle?

A PESA or TESA treatment cycle will involve the women undergoing a standard stimulated IVF cycle where the ovaries are stimulated to produce multiple eggs.

Frozen sperm samples are simply thawed and prepared on the day of egg collection or a fresh sperm sample will be obtained around the time of egg collection if required.

Are any tests required before treatment?

Investigations are required to help predict whether sperm can be obtained at the biopsy and for the presence of any condition that could cause problems in children born from the procedure.

Investigations include:

Hormone tests:

• Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH) and Testosterone are measured
• Very high FSH and LH and low Testosterone suggest testicles are not functioning well and chances of obtaining sperm are lower

Examination:

• If the testicles are very small, the chances of obtaining sperm are lower
• Conditions such as Congenital Absence of the Vasa Deferens may be identified by examination

Chromosome analysis:

• Some men will not produce sperm due to chromosome abnormalities
• This may not cause any problems other than sperm production but could cause problems for children
• It is very important we always check the man’s chromosomes before the biopsy

Y chromosome mircodeletion test

Cystic Fibrosis testing:

• One in every 25 people carry this gene, but it is more common in men who have absent vasa deferens
• If their partner also carries the gene, it increases the chance of the child being affected
• If the man has the gene, we then test his partner. Treatment can continue if she is negative
• Genetic counselling and support is available for positive tests

HIV and Hepatitis:

• All individuals storing sperm, eggs or embryos are screened for HIV and hepatitis B and C
• This rules out any chance of cross contamination in the laboratory and in embryo storage vessels

The female partner will also need to undergo fertility investigations before IVF treatment including;

• Hormone tests during the menstrual cycle to ensure that she is able to produce eggs
• Tests to check the womb
• Further investigations may be required in the clinic and will be fully discussed with you

What happens on the day of the Surgical Sperm Retrieval?

• A PESA procedure is performed to see if sperm are present
• If no sperm are found in the epididymis, a testicular aspiration (TESA) will be carried out
• You may experience some mild discomfort following the procedure, which should be relieved by simple painkillers like Paracetamol
• We advise supportive underwear and loose trousers be worn until the discomfort has settled

Are there any risks with Surgical Sperm Recovery?

The biopsy procedure carries a small risk of bruising and infection to the biopsy site.

How long can the sperm sample be stored?

We are able to store sperm for a maximum of 10 years.