After your Medical Consultation, we may advise you to have surgical sperm retrieval if your sperm count is too low in number or absent. It can be used following an unsuccessful vasectomy reversal or because:
- The sperm duct is blocked (obstructive azoospermia)
- The testicles aren’t producing enough sperm (non-obstructive azoospermia)
Surgical sperm retrieval (or recovery) is a technique used to retrieve sperm directly from the testicle. It can involve:
- Percutaneous Sperm Extraction (PESE)
- Testicular sperm extraction (TESE)
- Micro-testicular dissection using an operating microscope (M-TESE). In some cases, the Consultant will carry out a diagnostic mapping procedure before planning this procedure
These procedures are carried out at the Agora by either Mr Jonathan Ramsay or Mr Ehab Kelada under anaesthesia.
The retrieved sperm are frozen (cryopreserved) ready to be thawed. They are then used in IVF treatment with ICSI.
When there is no sperm, particularly when this is due to non-obstructive azoospermia, you may be offered hormone treatments to improve the chances of successful sperm retrieval.
What does SSR involve?
- Percutaneous epididymal sperm aspiration (PESA) is a short procedure that involves the doctor passing a very small fine bore needle through the scrotal skin directly into the epididymis. The sperm are collected in a small syringe and the fluid is then viewed under the microscope by the embryologist. Your doctor will be informed immediately if any sperm are identified. This procedure is usually performed under a local anaesthetic but some men may want or need to have light sedation
- Testicular sperm aspiration (TESA): if no sperm are retrieved from PESA, samples of tissue can be removed from the testes via TESABoth PESA and TESA retrieve small amounts of sperm that will only be suitable for treatment with intra-cytoplasmic sperm injection (ICSI). You can find out more about ICSI in the separate patient leaflet.
What happens if PESA or TESA do not work?
If PESA or TESA do not result in any sperm being found, it may be possible to retrieve sperm through open testicular biopsy. This involves making a small cut in the skin of the scrotum to take a biopsy of the testicular tissue before closing the skin again. However, the final decision to carry out an open biopsy or not depends on your overall clinical assessment and the results of laboratory tests.
How is the treatment carried out?
The Agora Clinic has a purpose built treatment room designed primarily for fertility procedures requiring embryology services such as egg collection, embryo transfer and SSR.
SSR is a day case procedure. During this time you will be cared for by our team of qualified staff who are experienced
in all aspects of fertility, day surgery and recovery. We aim to ensure that your procedure is carried out in a caring, professional and efficient manner, making your recovery as comfortable and relaxing as possible.
Before your procedure
Please arrive at the Agora Clinic by 8.00am on the day your procedure is scheduled. This allows enough time to go through the admissions procedure, talk with your doctor (and if appropriate the anaesthetist), and for us to answer any questions you may have regarding your care
- Do not have anything to eat on the morning of admission. You are, however, encouraged to drink plain water only up to two hours prior to the procedure
- You will be asked to complete a Health Questionnaire which will be discussed with you by one of the fertility nurses
- During your pre-operative assessment a nurse will measure your height, weight, blood pressure, pulse and discuss your general health
- If you are having sedation, this can make you drowsy and affect your coordination for the following 24-48 hour period so it is very important to arrange for an adult to accompany you home after the procedure and to stay with you overnight
- We do not recommend that you travel home by public transport, so please arrange for a private car or taxi to take you home
- Please leave any unnecessary valuables or jewellery at home as the Agora cannot be held responsible for any loss or damage to your property
- Please do not wear any aftershave
- Please bring this leaflet with you when you come for your procedure as it may be useful to refer to.
After your procedure
You should expect to stay at the Agora Clinic for about an hour to make sure you are fully recovered. Patients having sedation will need to stay longerYou should expect to stay at the Agora Clinic for about an hour to make sure you are fully recovered. Patients having sedation will need to stay longer
- You will be offered something to eat and drink before you leave
- Do not drive, or operate machinery (including domestic appliances) for 48 hours if you were given sedation
- Do not make important decisions or sign any contracts for 24 hours if you were given sedation, as your judgement may be impaired
- You may experience some slight discomfort afterwards. Please make sure you have some over-the-counter painkillers at home
- You are encouraged to wear supportive underwear for the next 48 hours to reduce inflammation and discomfort
- The puncture wounds should be kept clean and dry for 24 hours following the procedure after which time you may have a shower or bath
- If the puncture wounds become red, inflamed or painful, contact your consultant at the Agora or GP
- If you are worried or have any concerns following your procedure you should contact us.