This type of surgical sperm retieval (SSR) is commonly used in men whose vas deferens is blocked or who have had a vasectomy within the last five years. This simple procedure requires the use of local anesthetic and is the only type of SSR that is able to retrieve mature sperm.
During the procedure, a needle is inserted into the vas deferens, possibly through a small incision made in the scrotum, extracting the fluid inside. The vas deferens and epididymis are then massaged to produce additional liquid, which will also be removed. Extracted sperm is then prepared for IVF.
As this procedure removes sperm that has passed through the epididymis, and is therefore considered to be mature, sperm retrieved through vasal aspiration can be cryopreserved for use in future treatments and does not necessarily need to be used in conjunction with ICSI.
Micro-Epididymal Sperm Aspiration
This procedure is very similar to PESA except that in MESA, a tiny incision is made through the scrotum and into the epididymis. Fluid from the epididymal tube is then drained out and analyzed for sperm. This type of microsurgical treatment is generally recommended for men who do not have a vas deferens or have scar tissue in their vas deferens. MESA is usually done under general anesthetic.
Testicular Sperm Extraction
This type of SSR is reserved for men who have a blockage in their epididymis, close to the testicles, thereby preventing sperm from entering into the epididymis. It can also be used in men who have a blockage in the testicles or produce so little sperm that none of it reaches the ejaculate.
In testicular sperm extraction (TESE), immature sperm is collected through a testicular biopsy, a process that requires the removal of a small amount of testicular tissue. Local anesthetic is usually given before the surgeon makes a small incision in the testicles to remove the tissue.
A similar procedure, known as testicular sperm aspiration (TESA), also removes sperm directly from the testicles. However, in this procedure, no incision is made and instead a needle is inserted directly into the testicles in order to collect the sperm. Because sperm collected from the testicles are immature, it is necessary to use ICSI in order to fertilize an egg.
Concerns with SSR
Finding success with surgical sperm retrieval depends heavily upon the SSR method you undergo. PESA has the highest rate of retrieval associated with it, at 80% to 90%, while TESE tends to be much lower, with only 60% of patients having sperm retrieved.
As all of these methods require the use of IVF, and often ICSI as well, the chances of pregnancy tend to hover between 20% and 30%, again dependant upon the method of SSR used.
Another concern for many with SSR is the fact that, often, immature sperm are retrieved. Because TESE removes sperm that have never passed through the epididymis, some experts are concerned about using cells that are still evolving to achieve pregnancy.
In some instances, spermatids (round cells that have yet to develop into sperm with tails) may be removed through TESE. Although spermatids can be used with ICSI to cause pregnancy, it is still thought of as an experimental treatment.
Before deciding on SSR, discuss all the pros and cons of these procedure with your fertility doctor. It is also a good idea to come up with a back-up plan in case it is not possible to remove enough sperm through SSR.