Surgical Sperm Retrieval (SSR)

Azoospermia is a type of infertility that occurs where the husband has no sperm seen in the semen.

In half of these cases sperm production from the testes is normal, but there is a blockage, which prevents sperm from entering the semen.

This may be due to:-

• Failure of the sperm passages to develop (congenital absence of the vas).
• Blockage of the sperm transport tubes, e.g. by previous infection or scar tissue from previous groin operation.
• A previous vasectomy operation (male sterilisation).

In the other 50% of cases there is a failure of adequate sperm production by the testes, this could either be a congenital problem, a result of previous disease or cancer treatment.

ICSI (Intracytoplasmic Sperm Injection) is an advanced type of IVF treatment when fertilisation is achieved after injecting a single sperm in to each egg. With the benefit of ICSI we are able to obtain fertilisation from very few sperm obtained from men who are infertile due to problems mentioned above.

Sperm are removed through a variety of techniques;

PESA (Percutaneous Epididymal Sperm Aspiration), TESA (Testicular Sperm Aspiration) and TESE (Testicular Sperm Extraction).

These procedures will be carried out either under local anaesthetic or general anaesthetic, for diagnosis, immediate treatment or frozen for use in the future treatments.

PESA (Percutaneous epididymal sperm aspiration)

This is the first choice (if possible) to collect sperm. A fine needle is inserted through the scrotum into the epididymis and sperm are obtained by gentle suction. After each sample is collected, it is examined under the microscope to confirm the presence of sperm.

TESA (Testicular sperm aspiration)

A fine needle is inserted into the testis and sample of tissue are 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, sperm can then be extracted from the tissue. The cut is stitched back together with a couple of stitches, which self dissolve in about 10 days. Finding sperm in the testicular tissue can be a laborious process.

TESE (Testicular sperm extraction)

If few or no sperm are obtained a biopsy (tissue sample) is taken from the testes through a small incision. After the procedure 2-3 sutures are placed in the skin, these will dissolve after about 10 days

Surgically retrieved sperm are immature and incapable of fertilization by conventional means. Fertilization is achieved using ICSI, this involve injecting a selected sperm into the cytoplasm of a mature egg.

After the operation, You may feel discomfort, bruising and tenderness of the scrotum for 24-48 hours. This will be relieved with painkillers such as paracetemol.