Sperm Retrieval in Male Factor Infertility

Male factor infertility can have a number of underlying causes. For example, a patient who has had a vasectomy may produce healthy sperm but no sperm will be present in the ejaculate. Certain medical conditions and congenital abnormalities can also cause obstruction in the ejaculatory system. In other cases, there is no blockage but the patient produces very little viable sperm as a result of hormonal or genetic abnormalities. Sperm retrieval for use in fertility treatments is carried out surgically to work around these problems.

Surgical Interventions for Sperm Retrieval

Urologists use a procedure called MESA (Microsurgical Epididymal Sperm Aspiration) to collect sperm from a tube called the epididymis that lies along the back of the testis. Maturing sperm is stored in tightly coiled tubules within the epididymis, making this an ideal location for harvesting large quantities of viable sperm during a single procedure. The tubules are accessed through a ½” incision in the scrotal skin.

In TESE (Testicular Sperm Extraction), sperm is retrieved from within the testis itself by taking a small biopsy of the testicular tissue. Further processing must be carried out to identify and extract healthy for use in fertility treatment. This approach is generally reserved for male patients who have no sperm in the ejaculate rather than those who simply have an obstruction.

How is the Retrieved Sperm Used?

Sperm retrieved with MESA or TESE is used to fertilize an egg via intracytoplasmic sperm injection (ICSI) rather than intrauterine insemination. This method is used because the quantity of sperm extracted is too small for traditional insemination. Rather than using up all the retrieved sperm on an insemination attempt that is unlikely to succeed, ICSI introduces one sperm directly into the egg to ensure fertilization. The remaining sperm can be frozen for use in future IVF cycles.

Does the Procedure Hurt?

Sperm retrieval is an outpatient procedure done under local anesthesia. Conscious sedation is sometimes offered as well for further pain control. The operation usually takes about an hour. Most men report mild but lingering discomfort after the procedure. Return to sedentary work the day after the operation is the norm.