Surgical sperm retrieval (TESA or TESE) is offered to men who have no sperm in their ejaculate. Azoospermia has two causes: an obstruction in the tubes that carry sperm, or a defect in sperm production. Retrieval is more likely to succeed where obstruction is the cause, as testicular size and FSH levels are usually normal.

Surgical Sperm Retrieval

This is the procedure advised to men who do not have sperm in their ejaculate. Absence of sperm in the ejaculate may be due to two primary reasons:

• Obstruction in the tubules conducting the sperm
• Non-obstructive, which means there is a defect in sperm production

Obtaining sperm is more likely when you have obstruction as a primary reason. In men with obstructive absence of sperm (Azoospermia), the testicular size is usually normal (Largest diameter is ≥4 cm) and so is the FSH level (less than 7.2 IU/ml).

Preparation for the Procedure

• Routine blood tests will be done to assess your fitness for the procedure.
• You will be advised to come on an empty stomach on the day of the procedure.
• You will be given a small bottle of micro-shield wash solution to clean the scrotum for at least 3 days prior to the procedure.
• If you have any allergies, please notify the anesthetist before the procedure.
• If you are on any medication, please consult with the doctor. For thyroid issues, you can take the medication in the morning.
• An IV line will be sited and some pre-medication will be administered prior to the procedure.

Procedure

• The procedure will be done under IV sedation (Short GA) and therefore you will be asleep during the operation.
• Sometimes, it may be possible to retrieve the sperm by aspiration using a needle and syringe. This is more likely to be possible in men with obstruction.
• If sperm is not obtained by aspiration, a small incision will be made on your scrotum, and we will also open the testes and take tissue directly to examine under a microscope.
• Once this is done, the incision will be closed by absorbable stitches.
• The side effects of the procedure are minimal and include pain, mild bruising, and scrotal swelling which tend to settle within a week. Infection is very rare and can occur in 1 in 250 patients.
• In non-obstructive Azoospermia, 1 in 10 patients may not have sperm in the testes.

Post Procedure

• If you have pain, please request painkillers. We will give you antibiotics for 5 days after the procedure.
• Please ensure to use undergarments that are not too tight or too loose, ensuring adequate support.
• You should avoid sexual activity until the scrotum and testes are comfortable.
• If you have any persistent pain or discomfort or any other problem, please notify the hospital immediately– +918939994244
• You will not be able to drive on the day of the procedure.

How is surgical sperm retrieval done?

Who needs surgical sperm retrieval?

Men who have no sperm in the ejaculate, a condition called azoospermia. The cause is either an obstruction in the tubes carrying sperm or a problem with sperm production itself, and that distinction strongly affects the chance of retrieving sperm.

How do I know which type of azoospermia I have?

Testicular size and FSH are the first indicators. In obstructive azoospermia the testes are usually of normal size, with the largest diameter 4 cm or more, and FSH is below 7.2 IU/ml. Retrieval is more likely to succeed in this group.

How should I prepare for the procedure?

Routine blood tests assess your fitness. You will be asked to come on an empty stomach and given a micro-shield wash solution to clean the scrotum for at least three days beforehand. Tell the anaesthetist about any allergies and regular medication.

What is the difference between TESA and TESE?

Both obtain sperm directly from the testis. TESA uses a needle to aspirate tissue, while TESE takes a small piece of testicular tissue surgically. The choice depends on the likely cause and on what any previous attempt showed.

What happens to the sperm that is retrieved?

It is used to fertilise eggs by ICSI, where a single sperm is injected directly into each egg. Surplus sperm can often be frozen at the same time, which may avoid repeating the procedure for a later cycle.

What are the chances of finding sperm?

That depends chiefly on whether the cause is obstructive or non-obstructive. Where obstruction is the cause and testicular size and FSH are normal, retrieval usually succeeds. Where sperm production itself is impaired, the outcome is far less predictable, and your doctor will discuss what your hormone levels and examination suggest before proceeding.

Related reading

• TESA and PESA sperm retrieval in Chennai
• IVF treatment at Jananam Fertility Centre
• choosing a fertility hospital in Chennai

Clinical references

Independent clinical guidance relevant to this topic:

• WHO — Obesity and overweight
• NICE CG156 — Fertility problems: assessment and treatment
• NICHD — Infertility and fertility