Referring to any procedure carried out to extract sperm when there is no sperm in the ejaculate. This can be MESA, TESA, TESE or micro-TESE.
Surgical sperm retrieval is the professional collection of sperm from the epididymis (a narrow tube behind the test is where sperm are stored and mature) or the testicles. It is carried out in order to assist couples with fertility treatments, where the male partner has been found to have azoospermia (a condition in which the male partner is found to have no measurable sperm in their semen).
There are two types of azoospermia, both of which may be circumvented for fertility treatment by surgical sperm retrieval:
- Obstructive azoospermia, in which sperm are produced by the testes but are unable to be found in the ejaculated semen due to a blockage to the sperm transport or the absence of the vas deferens
- Non-obstructive azoospermia, in which the testicles are either not producing sperm or are producing very low numbers of sperm, and sperm is not present in the ejaculate
There are several different techniques and procedures available for the retrieval of sperm. The NHS has concluded that there is sufficient evidence to suggest routine commissioning of these on an individual basis, deciding the best technique based on whether the azoospermia is obstructive or non-obstructive, can assist conception:
- Percutaneous epididymal sperm aspiration (PESA)
- Microscopic (or microsurgical) epididymal sperm aspiration (or extraction) (MESA)
- Testicular sperm aspiration (TESA), which may also be described as testicular fine needle aspiration (TEFNA)
- Testicular sperm extraction (TESE)
- Microdissection testicular exploration and sperm extraction, or micro-testicular sperm extraction (micro-TESE or mTESE)
Most of these procedures are carried out in order to help couples conceive through intracytoplasmic sperm injection and in-vitro fertilisation (an ICSI IVF cycle). Each allows the male partner to father any child or children born from the process, without the help of donor sperm or the consideration of adoption. Both of these options may also be decided on at a later date, if the couple (or even a single patient) chooses to pursue them.
The sperm collected as part of the process can immediately be taken to be used in an ICSI procedure. This involves introducing and mixing individual sperm cells with eggs collected from the female partner or a donor, in the hopes of achieving fertilisation more easily than might have otherwise been possible. If fertilisation occurs, the developing embryo will then be placed into the female partner’s womb or the womb of a surrogate. From this, it is hoped that they will carry on with a successful pregnancy and give birth to a healthy child.
In the event that a surgical sperm retrieval procedure is successful, usually enough sperm will be collected for several cycles of treatment (if needed).