Surgical sperm retrieval
Some men produce no sperm in their ejaculate, some only produce very small numbers or intermittently, while for others there may be a physical problem that makes producing a sample of semen impossible.
In some of these cases, after suitable assessment a sperm retrieval procedure may be offered. The procedures involved allow mature sperm to be collected either from the tubes adjacent to the testis (the epididymis) or from the testis itself. If suitable this sperm can then be used in the IVF process. Sperm injection (ICSI) would be required to fertilise the eggs with the sperm.
PESA (percutaneous epididymal sperm aspiration)
In this procedure a small needle is inserted through the skin of the scrotum into the tubes adjacent to the testis. In men where there is an obstruction, these tubes are often swollen and the fluid within them can contain many mature sperm. The quality of the sperm can only be assessed once it has been retrieved, sometimes it can be frozen to avoid a repeat procedures being required.
If no sperm is retrieved from the epididymis or where a non-obstructive problem, or a problem with the sperm-making process is diagnosed, then a biopsy of one or both testes may be necessary. In this case a small cut is made in the scrotal skin and in the surface of the testis so that a small amount of tissue can be removed. A small dissolving stitch will allow easy healing of these wounds. In this case a small portion of the tissue may be sent for laboratory assessment of its structure and the sperm production process. The rest will be retained for sperm retrieval. Although it is less likely, mature testicular sperm can sometimes be frozen for future use.
Is this a suitable treatment for me?
If you have no sperm in your semen (azoospermia), then a sperm retrieval procedure may be possible. However, it does depend on the cause of the problem. For some men in this situation there is a hormonal problem which may be correctable without resorting to surgery. For others their testes cannot make sperm and an attempt to retrieve sperm would be unsuccessful. In some situations, removal of a blockage can be attempted. By investigating the function of your testes we can give advice about the chances of retrieving sperm suitable for IVF treatment, upon which you can base your decisions.
How does this fit with my partner’s treatment?
In most cases, to take advantage of fresh sperm, the sperm retrieval process is set up to coincide with your partners ovarian stimulation and egg retrieval. Sometimes it may be preferable to have carried out a diagnostic procedure first to ensure that it is possible to obtain sperm in this way. It may then be possible to freeze the sperm for your IVF cycle so that the sperm retrieval doesn’t need to be repeated.
All individuals storing either embryos or gametes must now be screened for HIV, Hepatitis B and Hepatitis C. We do not have storage facilities for couples or individuals who test positive for any of these conditions, so we would not be able to store sperm in that situation.
Do I need an anaesthetic?
For most men the sperm retrieval procedure is straightforward and can be performed under local anaesthetic. Occasionally a general anaesthetic may be necessary or recommended.
What if no sperm is retrieved?
If the procedure is a diagnostic one performed before the IVF process, then we will discuss the findings and future options with you in the clinic before you make final treatment choices. If the procedure is being performed in conjunction with your partner’s treatment this would be cancelled before egg collection.
Some couples prefer to avoid this difficulty by choosing donor sperm to be available as a back-up. This option will be discussed with you and appropriate counselling given before you make your decision. It may not be a treatment option you would want to take up. The use of donor sperm as a back-up must be arranged well in advance of treatment.
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