Sperm extraction techniques

What is sperm extraction?

Sperm extraction, also known as sperm retrieval or sperm aspiration, is a medical procedure used to obtain viable sperm for fertility treatments. In this procedure, a specialist extracts sperm directly from the testicles or epididymis using various techniques.

Why sperm extraction is needed?

There are several reasons why someone may need to undergo sperm extraction including:

Men who have undergone vasectomy but wish to conceive again can use this method to retrieve their own healthy sperm without undergoing surgery.
Retrograde ejaculation (when semen enters the bladder instead of exiting through the penis)
Genetic conditions that affect male fertility such as Klinefelter syndrome and cystic fibrosis,
Obstructive azoospermia where there is no visible presence of sperm in semen due to an obstruction in the reproductive tract.
When a man has difficulty ejaculating due to a medical condition or injury. In these cases, sperm can be extracted directly from the testicles using a needle and syringe.
If a man's semen analysis shows an extremely low concentration or motility of sperm, then he may need to undergo extraction for use during assisted reproductive techniques such as IVF.
When a man has undergone cancer treatment that affects his fertility. Chemotherapy and radiation can damage the testicles and reduce or eliminate sperm production, making extraction necessary if he wishes to father children in the future.

It's important to note that not all men with infertility issues will require surgical intervention like Sperm Extraction. A thorough evaluation by a specialist should always precede any decision about treatment options. It's important for anyone considering this procedure to discuss their options with their doctor and get all the information they need before making any decisions.

Note: While these procedures can increase the chances of conceiving a child, they aren't always guaranteed to be successful.

What are the different sperm extraction techniques?

Each technique offers its own unique benefits and drawbacks, making it important to understand the differences between them in order to make an informed decision about which one is right for you or your partner.

Testicular Sperm Extraction (TESE)

Testicular Sperm Extraction (TESE) is a surgical sperm retrieval technique that involves obtaining sperm directly from the testicles. This method is commonly used for men who have no viable sperm in their semen due to a blockage or absence of the vas deferens, congenital absence of the vas deferens (CAVD), or other medical conditions affecting sperm production.

Procedure:

During TESE, a small incision is made in the scrotum and a tissue sample is taken from one or both testicles. The tissue is then examined under a microscope to identify any viable sperm cells that can be used for assisted reproductive technologies like IVF or ICSI.
While TESE has proven to be effective in retrieving usable sperm, it does require general anaesthesia and carries some risks such as bleeding, infection, and damage to surrounding tissues. Additionally, success rates may vary depending on factors such as age and underlying medical conditions.

Benefits:

TESE can offer hope for couples struggling with male infertility

Testicular Sperm Aspiration (TESA)

Testicular Sperm Aspiration (TESA) is a sperm extraction technique used in cases where the testicles produce viable sperm, but they are not present in the ejaculate.

Procedure:

This procedure involves using a needle to aspirate fluid and tissue from the testicle, which is then examined under a microscope for viable sperm.
The TESA procedure is typically performed under local anaesthesia and takes approximately 30 minutes to complete.
It can be done on an outpatient basis, allowing patients to return home the same day.

Benefits:

TESA offers hope for couples struggling with male infertility due to low or absent sperm count.
One of the benefits of TESA is that it can usually be performed even if there are very few or no mature sperm present in the testicles. This makes it an option for men who have previously undergone failed procedures such as varicocele repair or vasectomy reversal.

Risks:

Bleeding
Infection
Damage to surrounding tissues or organs.

TESA with Mapping

TESA with Mapping is a relatively new technique used for sperm extraction in men who have obstructive azoospermia. It involves the use of ultrasound imaging technology to map the epididymis and identify areas where sperm are most likely to be present.

Procedure:

The procedure begins with a detailed ultrasound examination of the scrotum, which helps locate any blockages or abnormalities in the reproductive system. Once this is done, small needles are inserted into various parts of the epididymal tubules under local anaesthesia.
Once enough samples are collected, they are sent to a laboratory for further analysis and processing before being used for fertilization procedures such as IVF or ICSI.

Benefits:

TESA with Mapping has several advantages over other techniques such as PESA or MESA because it allows doctors to obtain higher-quality sperm samples while minimizing damage to surrounding tissue.
This not only increases success rates but also reduces recovery time for patients undergoing fertility treatments.
TESA with Mapping is an effective and minimally invasive technique that has shown promising results in helping couples overcome infertility caused by obstructive azoospermia.

Microsurgical Epididymal Sperm Aspiration (MESA)

Microsurgical Epididymal Sperm Aspiration (MESA) is a surgical sperm retrieval technique that involves the use of an operating microscope to access and extract sperm from the epididymis. This procedure is typically recommended for men who have blocked or damaged vas deferens, which prevents the natural ejaculation of sperm.

Procedure:

During MESA, a small incision is made in the scrotum, and the epididymis is located with an operating microscope. The surgeon then carefully removes fluid from the epididymal tubules using a fine needle, which contains live sperm cells.

Benefits:

The advantage of MESA over other techniques like PESA lies in its higher success rate as it retrieves more mature sperms that are better suited for fertilization.
It also reduces damage to surrounding tissues due to its precision since only tiny amounts of tissue are extracted during this process.
Infection or bleeding. However, these risks are minimal when performed by experienced and qualified surgeons.

Percutaneous Epididymal Sperm Aspiration (PESA)

Percutaneous Epididymal Sperm Aspiration (PESA) is a sperm extraction technique that involves the use of a needle to aspirate sperm from the epididymis. This method is often used for men who have obstructions in their reproductive system, preventing natural ejaculation.

Procedure:

During a PESA procedure, local anaesthesia is applied to the scrotum to reduce pain and discomfort. A small needle is then inserted into the epididymis through the skin of the scrotum, and suction is applied to retrieve fluid containing sperm cells.

Benefits:

One advantage of PESA over other techniques like MESA or TESE is that it can be performed quickly without requiring extensive surgery.
Additionally, since only one puncture site is required, there may be less postoperative pain and faster recovery times.
It helps in extracting sperm with motility as high as 29%

Risks:

The amount of sperm retrieved during this procedure may be limited compared with other methods such as Micro-TESE or TESA with Mapping.
Additionally, there may be an increased risk of damage to surrounding tissues due to its blind nature.

While PESA can be an effective option for some patients in certain situations, it's important to consult with your doctor about which sperm extraction technique might best suit your individual needs before making any decisions regarding fertility treatment.

Microsurgical Testicular Sperm Extraction (Micro-TESE)

Micro-TESE is solely performed for non-obstructive azoospermia.

Procedure:

The testicle's outer covering is opened to inspect the interior. The urologist can identify areas with higher potential for sperm production. A microsurgery-trained urologist performs this procedure, typically in an operating room.

Benefits:

Micro-TESE enables a more thorough examination of the testis with minimal tissue removal and reduced damage to blood vessels.
It is believed by some that Micro-TESE provides a greater likelihood of locating sperm in patients with non-obstructive azoospermia.

Key Takeaway:

Sperm extraction techniques are used to help men and couples who have fertility problems.
This technique involves obtaining viable sperm directly from the testicles or epididymis using various procedures such as percutaneous epididymal sperm aspiration (PESA), testicular sperm extraction (TESE) and microsurgical epididymal sperm aspiration (MESA).
Sperm extraction may be recommended for men who have undergone vasectomy, have retrograde ejaculation or genetic conditions that affect male fertility, or have undergone cancer treatment.
While these procedures can increase the chances of conceiving, it's important to note that they aren't always guaranteed to be successful.
Seeking professional guidance is important for couples struggling with infertility.

Frequently asked questions

Is sperm retrieval painful?
What are the risks of sperm extraction?
You may experience bleeding, infection, discomfort

Reference

Dr Purva Singh

MBBS MS OBGYN
IVF Specialist