Use of Surgery to Obtain Sperm (Surgical Sperm Extraction)
Male factor infertility can result in a variety of issues such as complete absence of sperm in the ejaculate (azoospermia) due to either an obstruction/blockage (obstructive azospermia) often caused by a previous vasectomy or congenital-birth defects or failure of sperm production by the testicles (non-obstructive azospermia). For these conditions, there is a surgical option of retrieving sperm from either the vas deferens, epididymis or testis to be used in an IVF cycle(s) to conceive. Because the surgically retrieved sperm are immature, fertilization is achieved by injecting selected sperm directly into the egg by a process called intracytoplasmic sperm injection (ICSI).
Males considering this option are required to see a urologist prior to surgery to assist with determining the best approach for retrieving sperm including:
Microsurgical Epididymal Sperm Aspiration (MESA)
MESA collects sperm by aspirating fluid from the epididymis of the male reproductive tract. A fine needle is inserted through the scrotum into the epididymis and sperm are obtained by gentle suction. This procedure is used for cases of obstructive azospermia
Testicular Sperm Aspiration (TESA)
TESA is where a fine needle is inserted into the testis and a sample of tissue is obtained by gentle suction and examined under the microscope. If sperm are not found, a small tissue sample (testicular biopsy) is taken through a small incision in the scrotum and testis, where sperm can then be extracted. This procedure is used for cases of non-obstructive azospermia.
If possible, MESA and TESA procedures are timed to coincide with the egg retrieval step during the IVF cycle. For some, scheduling may be an issue; Surgical Sperm Retrieval can be completed before the IVF cycle beings and frozen (cryopreserved) for future use. The extraction of sperm completed by MESA and TESA typically results in enough sperm to allow several IVF cycles. These procedures can be performed on an outpatient basis using sedation to eliminate any pain or discomfort.