Surgical Sperm Retrieval: When Is It Needed and What Does the Procedure Involve?

Producing sperm and releasing sperm are not always the same thing. A man may be producing sperm, but none may appear in his semen because the pathway is blocked. In other cases, the testes may be producing sperm only in very small quantities. The difference is important because it shapes what can be done next, says Dr Shyla Usman Ali, Fertility Specialist, Birla Fertility & IVF, Chennai. 

When sperm cannot be obtained from the semen, doctors may consider retrieving it directly from the epididymis or testes. These techniques are collectively known as surgical sperm retrieval. If viable sperm are found, they can be used for ICSI, a fertility treatment in which a single sperm is injected into an egg.

When may sperm retrieval be needed?

Sperm retrieval is most often considered for men with azoospermia, which means that no sperm is detected in the semen.

In obstructive azoospermia, sperm production may be normal, but a blockage prevents sperm from entering the ejaculate. The blockage could be linked to an infection, injury, previous surgery or a condition present from birth.

Non-obstructive azoospermia is different. Here, sperm production itself is severely reduced. Even then, sperm may sometimes be present in small areas of the testicular tissue. Retrieval may also be considered for men who are unable to ejaculate because of certain medical conditions or injuries.

What happens during sperm retrieval?

The procedure is chosen according to where sperm are most likely to be found.

PESA uses a fine needle to draw sperm-containing fluid from the epididymis and is commonly used when there is a blockage. TESA collects a small amount of tissue directly from the testis using a needle.

TESE involves making a small incision and removing testicular tissue for examination. Micro-TESE is a more specialised procedure performed under surgical magnification. It allows the surgeon to search for areas of tissue that are more likely to contain sperm and may be advised in certain cases of non-obstructive azoospermia.

Depending on the technique, local or general anaesthesia may be used. Any sperm retrieved can be used in the same IVF-ICSI cycle or frozen for future treatment.

Sperm retrieval is not suitable for every man with azoospermia, and its success cannot be assured. Before recommending it, the doctor may advise repeat semen analysis, hormone tests, genetic testing or imaging. Understanding the cause first helps the fertility team choose the right approach and explain the possibilities honestly to the couple.