Surgical sperm retrieval (SSR) is a surgical procedure that is used to extract sperm from the male reproductive tract for use in assisted reproduction techniques such as in vitro fertilization (IVF). In India, SSR is typically performed in cases where a man has a condition that makes it difficult or impossible for him to ejaculate or produce sperm naturally. Common causes of infertility in men include congenital defects, injury, infection, or obstruction of the reproductive tract. SSR procedures such as TESA, PESA, MESA and TESE are usually done under general anaesthesia and typically take between 30 minutes to an hour to perform. The extracted sperm can be used immediately for IVF or frozen for later use. The success rate of Surgical sperm retrieval (SSR) varies depending on the underlying cause of infertility and the specific procedure used.

Surgical sperm retrieval is a procedure that is used to obtain sperm from a man who is unable to produce sperm through ejaculation. The sperm can then be used for assisted reproductive techniques such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) to help couples who are struggling with infertility. There are several different techniques that can be used for surgical sperm retrieval, including testicular sperm extraction (TESE), percutaneous epididymal sperm aspiration (PESA), and microsurgical epididymal sperm aspiration (MESA). These procedures can be done on a daycare basis and typically involve a small incision or needle puncture to extract the sperm.

Surgical sperm retrieval (SSR) is a procedure used to obtain sperm from men who have difficulty producing sperm through ejaculation. The procedure is typically performed in men who have been diagnosed with a condition known as azoospermia, which is the absence of sperm in the semen. Surgical sperm retrieval (SSR) is done by surgically removing sperm from the testicles or epididymis using a small needle and syringe or a more invasive procedure known as microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE). The sperm obtained can then be used for assisted reproductive techniques such as in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Surgical sperm retrieval (SSR) is commonly done in India, as it is a cost-effective country with good quality of medical facilities.

Tests required before surgical sperm retrieval

A man who has no sperm in his semen is said to have azoospermia. This occurs due to the blockage in any of the tubes carrying sperm from the testes where they are produced, towards the penis during ejaculation. Obstructive azoospermia could be a result of testicular cancer, as the tumor presses against the vas deferens. This cancer commonly occurs in young men and can be treated successfully. Unfortunately, it can lead to male infertility, thus surgical sperm retrieval is necessary to store some sperm before starting the treatment.

Other reasons that can cause non-obstructive azoospermia, include an abnormal cystic fibrosis gene. Men suffering from this condition fail to exhibit all the symptoms, but they often suffer a lack of vas deferens. Surgical sperm retrieval is possible but there is an equal chance that the embryos produced further by the process of ICSI and IVF will carry a similar genetic abnormality. The options that are then left are using a sperm donor and the use of intrauterine insemination (IUI) or even IVF. Pre-implantation genetic diagnosis (PGD) can also be carried out on the embryos for selecting the one that carries the normal gene.

Surgical sperm retrieval techniques are used when the obstruction is the problem

When the release of sperm is prevented by a blockage in the vas deferens, or by a vasectomy, several techniques can be used to retrieve the large numbers of sperm that remain inside the testes. The first three involve aspirating sperm using needles or tubes placed through the skin of the testis and are carried out under local anesthetic. The fourth requires open surgical sperm retrieval and is usually carried out under general anesthetic.

01.TESA:

TESA refers to testicular sperm aspiration, which involves keeping a needle attached to a syringe through scrotum skin and drawing out the fluid from the testicle.

02.PESA:

This refers to the percutaneous epididymal sperm aspiration. This also makes use of the same needle and syringe technique but in this case, the needle is put directly into the epididymis.

03.Perc biopsy:

Perc biopsy is the short form for percutaneous biopsy of the testis. This is quite close to TESA, but it makes use of a larger needle, which is a 14 gauge needle used for biopsy of the testicular tissue and it usually extracts a large number of sperm.

04.Perc biopsy:

MESA is the microsurgical epididymal sperm aspiration that is the technique of open surgical sperm retrieval using operating microscopy for locating the tubules of the epididymis precisely, for the extraction of large numbers of sperms.

Certain studies have been conducted for comparing the success rates after doing the different types of sperm retrieval through surgery. MESA is thus known to give the highest number of sperm, recovered when compared with procedures like TESA and perc biopsy.

MESA produced sperms, which were better swimmers and thus more effective for infertility treatments, including IVF and ICSI..

Surgical sperm retrieval techniques when there is no obstruction

Men who lack any sperm in their semen, even after having clear tubes in their testicles, have an underlying problem with the process of sperm production. It is very less likely that sperm are present in large numbers, so the sperm retrieval through surgical techniques required are more invasive.

TESE: it refers to testicular sperm extraction that involves opening up the scrotum through a surgical incision and then taking a chunk of testicular tissue, derived from several regions of the testicle. Sperm are then extracted using a microscope for taking out the individual sperm.
Microdissection TESE. It is a similar technique using a micro dissecting microscope that is used to remove the tissue through a pinpoint. This procedure is helpful as it causes less damage to the structure inside the testicle, and thus has very less side effects like problems with blood supply by cutting with tiny blood. It can also enhance the number of sperm that are to be retrieved.

The main techniques used for the retrieval of sperm surgically are

PESA: the pit is the percutaneous epididymal sperm aspiration.
MESA: it refers to microsurgical epididymal sperm aspiration.
TESA: TESA refers to testicular sperm aspiration. This process includes testicular fine needle aspiration (TFNA).
TESE: This method is also known as testicular sperm extraction.

Microdissection TESE

Perc biopsy: this process refers to the percutaneous biopsy of the testis. Which method will be used depends upon what the underlying problem is in the male partner, which needs complete and careful evaluation first.

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

Who should undergo sperm retrieval?

Sperm retrieval is typically recommended for men who have been diagnosed with infertility due to a condition that affects their ability to produce or ejaculate sperm. This can include conditions such as azoospermia (no sperm in the semen), necrospermia (dead sperm in the semen), and retrograde ejaculation (ejaculation into the bladder rather than out of the penis). Sperm retrieval can also be used in situations where a man is unable to ejaculate due to spinal cord injury or other neurological conditions, or as part of assisted reproductive technologies such as in-vitro fertilization (IVF).

Why Choose India IVF Clinic?

There are several reasons why someone might choose an IVF clinic in India, including:

Cost: IVF treatment in India is significantly less expensive than in many other countries, making it accessible to a wider range of people.
Success rates: Some IVF clinics in India have high success rates, and may offer advanced technologies such as genetic testing.
Expertise: Indian IVF clinics have experienced and highly trained doctors and staff who specialize in the field of fertility.
Availability: IVF treatment is widely available in India, making it easy to find a clinic in a convenient location.
Support: Many Indian IVF clinics offer emotional and psychological support to patients going through the IVF process.
Convenience: India is a popular tourist destination, and many IVF clinics offer packages that include accommodation and travel arrangements.

FAQs

How is the sperm retrieval procedure decided?

The decision to perform a sperm retrieval procedure is typically made by a specialist, such as a urologist or a reproductive endocrinologist, after a thorough evaluation of the patient's medical history and a physical examination. Factors that may be considered when deciding whether to perform a sperm retrieval procedure include the cause of the patient's infertility, the patient's age, and the patient's overall health. Additionally, the patient's preferences and goals for treatment will also be taken into account. Sperm retrieval procedures like TESA, PESA, TESE, Micro TESE etc. are done depending on the patient's condition.

Is the sperm used immediately after retrieval?

Sperm retrieved during a sperm retrieval procedure, such as a testicular sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA), can be used immediately or frozen for later use. The decision of whether to use the sperm immediately or to freeze it will depend on the individual situation and fertility goals of the patient.

What are the side-effects of sperm retrieval procedures?

Sperm retrieval procedures, such as Testicular Sperm Extraction (TESE) or Percutaneous Epididymal Sperm Aspiration (PESA), can have some potential side-effects. These may include pain or discomfort at the site of the procedure, bleeding, infection, and damage to surrounding tissue. Additionally, there is also a small risk of complications related to the anesthesia used during the procedure. However, these side-effects are generally rare and the procedure is considered safe. It is important to consult with a specialist and discuss any concerns before undergoing the procedure.

What is the recovery period after sperm retrieval?

The recovery period after sperm retrieval can vary depending on the method used. For a testicular sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA), the recovery period is typically minimal, with patients able to return to normal activities the next day. For a microsurgical epididymal sperm aspiration (MESA) or testicular sperm aspiration (TESA), the recovery period may be slightly longer, with patients typically able to return to normal activities within a 1-2 days. In all cases, patients should follow any post-procedure instructions provided by their doctor and avoid any activities that could cause injury to the area where the procedure was performed.

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Tests required before surgical sperm retrieval

Surgical sperm retrieval techniques are used when the obstruction is the problem

01.TESA:

02.PESA:

03.Perc biopsy:

04.Perc biopsy:

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Surgical sperm retrieval techniques when there is no obstruction

Who should undergo sperm retrieval?

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