Sperm retrieval is a microsurgical procedure used to harvest sperm in the case of little or no sperm present in the ejaculate. Sperm retrieval is proven effective for obtaining healthy, viable sperm for in vitro fertilization (IVF). The fertility specialist will determine the best method of sperm retrieval based on the male partner’s semen analysis.
Around 33% of infertility is attributed to male factors, with another 10% attributed to both male and female issues. Certain medical conditions and exposure to toxins can damage the cells that produce sperm or affect the release of sperm. Chronic illnesses and diseases that affect sperm include cystic fibrosis, cancer, undescended testes, and diabetes. Exposure to radiation, chemotherapy, androgens, gym supplements, and certain herbs can inhibit or affect sperm production.
Indications for Surgical Sperm Retrieval
The fertility clinic can obtain sperm for men with the following conditions:
Failure to ejaculate
Obstructive azoospermia (sperm cannot pass through urethra or into semen)
Non-obstructive azoospermia (men who have no sperm count and no blockage)
Total necrozoospermia (all sperm are immotile but viable)
Microsurgical Epididymal Sperm Aspiration (MESA)
If the man has sperm present in the epididymis, microsurgical epididymal sperm aspiration can be performed for sperm retrieval. The procedure involves a small incision made in the scrotum under local anesthesia. A small, plastic pipette is used to accurately and quickly puncture the epididymal tubule. After the sperm are examined under the microscope for viability, the incision is closed with sutures.
Percutaneous Epididymal Sperm Aspiration (PESA)
With the PESA procedure is used for men who have obstructive azoospermia or prior vasectomy. This procedure is done using local anesthesia in a surgery room, coordinated with the female partner’s egg retrieval procedure. In an analysis of numerous studies, PESA was successful 83% of the time, but the associated ICSI pregnancy rate was 35% per embryo transfer.
Testicular Sperm Extraction (TESE)
For men with no sperm or a low count in the epididymis, or men with no epididymis, sperm can be retrieved directly from the testicles. The testicular sperm extraction (TESE) involves removal of a small sliver of testicular tissue, which is dissected under a microscope. Testicular sperm yields similar pregnancy success rates as epididymal sperm. Any excess sperm can be cryopreserved (frozen).
Retrieved Sperm for In Vitro Fertilization (IVF)
When used for in vitro fertilization, the sperm are concentrated in the laboratory for mixing with eggs. Using intracytoplasmic sperm injection (ICSI), a single sperm can be injected into an egg. Many couples with male factor infertility have conceived using IVF with various sperm extraction methods. Using this method, the live birth rate is around 35%.
The “Washing” Procedure
Sperm washing is the process where individual sperm are separated from the liquid semen. This involves removal of non-motile sperm and any mucus in the semen, which improves the chances of fertilization and assures the sperm are free of diseases. Sperm washing occurs in a density gradient centrifugation process or by the “direct swim-up” technique.
Washed sperm are concentrated in Hams F10 media without L-glutamine, and they are warmed to 99 °F. Chemicals are added to the sperm to assist the freezing and thawing processes. For HIV-positive males, because infection is carried in the seminal fluid, sperm washing can be used. However, the fertility specialist cannot 100% guarantee that the sperm will be free of the virus following the washing.