Surgical Sperm Retrieval

PESA / TESA / MESA

The main methods of surgical sperm retrieval available include:

• PESA: percutaneous epididymal sperm aspiration.
• MESA: microsurgical epididymal sperm aspiration.
• TESA: testicular sperm aspiration. This includes testicular fine needle aspiration (TFNA).
• TESE: testicular sperm extraction.
• Microdissection TESE.
• Perc biopsy: percutaneous biopsy of the testis.

Which method is used depends on the nature of the problem in the male partner, which needs to be explored carefully first.

Tests required before surgical sperm retrieval

A man that produces no sperm in his semen is said to have azoospermia. This may be because of a blockage in one of the tubes that carry sperm from the areas of the testes where they are produced, out to the penis during ejaculation. Obstructive azoospermia can be caused by testicular cancer, as the tumour presses on the vas deferens. This type of cancer is common in young men and can be treated successfully. It can, however, lead to infertility, so surgical sperm retrieval may be performed to store some sperm before treatment begins.

Other conditions cause non-obstructive azoospermia, including having an abnormal cystic fibrosis gene. Men with this condition may not show all the symptoms, but they often have no vas deferens. Surgical sperm retrieval is possible but there is a 50:50 chance that the embryos produced by subsequent ICSI and IVF will have the same genetic abnormality. Options then include using a sperm donor and intrauterine insemination (IUI) or IVF, or having pre-implantation genetic diagnosis (PGD) performed on the embryos to select ones that carry the normal gene.

If the problem that underlies poor sperm production is physical rather than genetic, or if a couple wants to have children after the male partner has had a vasectomy that cannot be reversed, surgical sperm retrieval can go ahead.