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Surgical Sperm Retrieval

Surgical Sperm RetrievalOur Consultant Urological Surgeon Steve Bromage is a leading expert in the field of surgical sperm retrieval (SSR). Surgical sperm retrieval is a surgical way of collecting sperm from men who aren’t producing sperm in their sample (called azoospermia).

Azoospermia may be due to: a blockage in the tubes that transport the sperm, vasectomy, failed vasectomy reversal or as a consequence of low or no sperm production in the testicle.  All men with azoospermia require evaluation and investigation by a urologist with specific expertise in male-factor problems so that the most appropriate technique may be utilised to help achieve a successful outcome for you as a couple.

SSR may be used in isolation or may be combined with reconstructive procedures to re-establish ejaculation of sperm, such as vasectomy reversal and epididymo-vasostomy. The techniques of SSR we use are percutaneous epididymal sperm aspiration (PESA), micro-epididymal sperm aspiration (MESA) or open or closed testicular sperm extraction (oTeSE or cTeSE).  With PESA and MESA the sperm is aspirated from the epididymis and with TESE, the sperm is extracted directly from the testis. Microdissection testicular sperm extraction (mTeSE) is a newer technique which is particularly applicable for attempting sperm retrieval from men with so-called non-obstructive azoosperma (NOA) when the lack of sperm is due to an intrinsic problem with the testicle's ability to produce sperm.

PESA and cTeSE can be carried out under local anaesthesia and sedation on a daycase basis. MESA, o and mTeSE necessitate a general anaesthetic, again as a day case procedure. Any sperm recovered is usually frozen before the IVF cycle commences so you know the viability of the retrieved sperm being used to achieve fertilisation.  As the number of sperm collected by SSR is low, we always use ICSI as the method of fertilising eggs retrieved during the subsequent IVF treatment.

In our experience testicular sperm aspiration (TeSA) and single puncture TeSE are not effective ways of retrieving sperm and are not something we would generally recommend.

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