Azoospermia (total absence of sperm in the ejaculate) can be due either to a blockage, absence of the vas deferens or to a failure of the testes to produce sperma. The degree of this failure can be variable.

It is however possible to recover sperm directly from either the testis itself or from the epididymis, which is like a small reservoir attached to the testis. This is called surgical sperm collection. Sperm that is collected in this way is not able to fertilise the egg in the natural way and ICSI is always necessary. This leads to a fertilisation rate of around 65%.

In cases of testicular failure, it is now possible in around 50% of cases to collect at least a few sperm by performing one or multiple testicular biopsies. Provided some motile sperm are recovered, the chance of fertilization of the egg is again extremely good.

Surgically collected sperm can be frozen and kept in storage so that it can be used during subsequent ICSI treatment.

Techniques for Surgical Sperm Recovery

This procedure is usually performed under local anaesthetics. Patients will be able to go home 1 to 2 hours later.

Percutaneous Epididymal Sperm Aspiration (PESA)

  • The technique is generally used where there is a blockage.
  • Here the sperm is aspirated directly from the epididymis, (tube containing the sperm), with a very fine needle which has been inserted through the scrotal skin.Here the sperm is aspirated directly from the epididymis, (tube containing the sperm), with a very fine needle which has been inserted through the scrotal skin.
  • The embryologist will then check the sample for the presence of sperm, under the microscope.

Testicular Sperm Extraction (TESE)

  • TESE, is used in cases of non-obstructive azoospermia, or if PESA has been unsuccessful.
  • This technique involves the collection of sperm directly from the testis.
  • The patient may require an additional injection of intravenous drugs, to achieve a mild degree of sedation.
  • A special needle, which allows the surgeon to recover several samples of testicular tissue from different locations, is used.
  • Where necessary a small cut ( sometimes multiple cuts ) is made into the testis to obtain tissue that is examined under the microscope to recover sperm. It is usually necessary to place a fine stich(es) on the wound and prescribe a short course of an appropriate antibiotic and a pain killer at the end of this procedure.