Surgical Sperm Retrieval (SSR)

Surgical sperm retrieval may be a treatment option for men with:

• An obstruction preventing sperm release, due to injury or infection
• Congenital absence of the vas deferens (men born without the tube that drains the sperm from the testicle)
• Vasectomy
• Non-obstructive azoospermia - the testicles are producing such low numbers of sperm that they don't reach the vas

In the first three of these cases, sperm are produced by the testes, but are unable to be ejaculated because of the blockage or absence of the vas. The man can still ejaculate seminal fluid but this fluid will not contain any sperm. It is possible to collect sperm directly from the epididymis.

Occasionally it may be possible to surgically repair the blockage although this has a low success. In cases of vasectomy surgical correction may offer as good if not better chance of a pregnancy than surgical extraction of sperm and ICSI.

In cases of non-obstructive azoospermia (complete absence of sperm) very small amounts of sperm may be produced and can be collected directly from the testes. This is done by performing multiple testicular biopsies at random. In these cases a biopsy will normally be sent to the laboratory for analysis as to the possible cause of the problem.

In men with obstructive azoospermia there is a very high chance of recovering sperm by this method (>90%). In men with non-obstructive azoospermia the chances of recovering sperm is approximately 40%. If we are successful at retreiving sperm the pregnancy rate for this treatment is very similar to that of ICSI with ejaculated sperm.

Techniques

PESA (Percutaneous epididymal sperm aspiration) is the collection of sperm through a fine needle directly from the epididymis, where sperm is stored, after it is formed in the testes.

TESE (Testicular sperm extraction) is the collection of sperm from a biopsy or several biopsies from the testicular tissue after makig a small incision in the scrotal skin.

The above procedures are carried out either under laocal anaesthetic or a sedation type of anaesthetic and require only a few hours in hospital. The material collected will be examined and you will be advised on the same day about the<> quality of the material and whether there is any sperm present. Any material with sperm will be frozen and place in storage for use at a later stage. These specimens are then thawed and used to inject the eggs obtained during IVF treatment using the technique of ICSI. If surgical retrieval of sperm is successful, usually enough sperm is obtained for several cycles of treatment (if required).