What is Surgical Sperm Retrieval?

After your Medical Consultation, you may be advised you to have surgical sperm retrieval if your sperm count is too low in number or absent.

This might be because the sperm duct is blocked (obstructive azoospermia) or because the testicles aren’t producing enough sperm (non-obstructive azoospermia). It can also be used following an unsuccessful vasectomy reversal.

Surgical sperm retrieval (or recovery) is a technique used to retrieve sperm directly from the testicle when there is suspected obstruction. It can either involve direct Testicular Sperm Extraction (TESE), micro-testicular dissection using an operating microscope (M-TESE) or Percutaneous Sperm Extraction (PESE).

These procedures can be 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 and used in IVF treatment with ICSI.

When there is an absence of sperm, particularly when this is due to non-obstructive causes (non-obstructive azoospermia), the chances of successful sperm retrieval may be improved by hormone treatments where appropriate and sometimes by undertaking a diagnostic mapping procedure before planning a micro-testicular dissection (M-TESE).

What causes azoospermia?

Although most cases of male infertility remain unexplained, there are two reasons why you may be affected by azoospermia (no sperm in the ejaculate):

  • Obstructive azoospermia: this means that there is an obstruction in the tubes transporting the sperm from the testes to the outside. This might be because you have had a vasectomy or damage to the vas deferens (the tubes that carries the sperm) during a hernia operation. Sometimes the obstruction can be due to recurrent genital infection. Also, men who are carriers of cystic fibrosis may have congenital absence of the vas deferens (this means they are born without the vas deferens). If the testes are producing sperm it is usually possible to have an SSR procedure.
  • Non-obstructive azoospermia: usually, the underlying reason for this is that the testes are not producing sperm (testicular failure). However, many men with non-obstructive azoospermia do have small areas of normal sperm production within the testes. Up to 50% of men with supposed untreatable infertility may produce small numbers of normal sperm. In some cases it is possible to find the sperm and recover them via an SSR procedure.

What tests do you offer?

In some cases there is an inherited (genetic) reason for azoospermia or a low sperm count which may be identified by screening for possible genetic disorders. The tests we advise are:

  • Karyotype (chromosome) test: a blood test to check chromosome abnormalities which are found in 5-10% of men with azoospermia or very low sperm counts.
  • Cystic fibrosis test: this is the most common genetic condition affecting Caucasians.It is believed that about 70% of men with azoospermia due to congenital absence of the vas deferens are carriers for cystic fibrosis. Therefore, we advise men with no sperm in the ejaculate to be screened for this condition
  • Hormone profile: a blood test to check the level of hormones (FSH, LH, testosterone and prolactin); this can indicate whether or not the testes are producing sperm.

What is an Enhanced Male Fertility Assessment?

An enhanced male fertility assessment involves more detailed male fertility tests.

It includes some additional tests of sperm health and function. And it gives a far greater insight into your reproductive health.

It can be very helpful if previous or home sperm tests have been normal and your infertility remains ‘unexplained’. Or when these tests have been abnormal but you have not been given an explanation as to why.

Sperm DNA fragmentation (SDF) is known to be higher in infertile men. Testing for Sperm DNA fragmentation measures the quality of sperm as a DNA package carrier, and it therefore is more significant than the parameters analysed in standard semen analyses.

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