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Normally sperm are produced in a region of the testes called the seminiferous tubules and are then stored in a region known as the epididymis where they mature. At the time of ejaculation they travel up a tube known as the vas deferens (this is the tube that is cut during vasectomy) and are mixed with excretions which mainly originate in the prostate, seminal vesicles and bulbourethral glands before being ejaculated as semen.

In some individuals sperm cannot reach the semen because there is a blockage somewhere in the testicle or part of one area is absent or abnormal. In cases such as this the diagnostic semen analysis will show that there were no sperm present this is known as Azoospermia.

In such cases sperm can be artificially removed from the area situated directly before the blockage. Sperm recovered from the testes in this manner are less mature than those normally found in semen because they have had less time to develop. They are usually not capable of fertilising an egg naturally. For this reason the sperm will be used in conjunction with ICSI (intra-cytoplasmic sperm injection).

Sperm Recovery Procedures

There are several sperm recovery procedures, they are all minor operations and include:

1. PESA- Percutaneous Epididymal Sperm Aspiration

A fine needle is passed through the skin of the scrotum and into the epididymal region of the testes. Sperm are drawn off and used in the ICSI procedure. This procedure is carried out under local anesthetic.

2. TESA- Testicular Sperm Aspiration

This is used if PESA is unsuccessful or not possible. The needle is inserted in a lower region of the testes and a small piece of testicular tissue is removed. This may be carried out at a number of different sites on the testes to collect sufficient sperm. This procedure is carried out under local anaesthetic.

3. TESE- Testicular Sperm Extraction

This is used if PESA or TESA are unsuccessful or not possible.
TESE involves the removal of some tissue from the testicle either by open operation (under sedation) or using a biopsy needle (general or local anesthetic). This tissue is then examined in the laboratory for the presence of sperm.

4. MESA- Micro Epididymal Sperm Aspiration

This technique uses a small needle to aspirate relatively mature sperm from the epididymis and is suitable for patients who have a blockage or absence of the vas deferens. It is an open procedure and is therefore only attempted in theatres under general anaesthetic. Usually MESA is attempted at the same time as another procedure such as vasectomy reversal.

Preparing for the Operation

You would be required to shave your scrotum the night before the operation and eat nothing after midnight.

After the Operation in India

MESA and sometimes TESE are carried out under a general anaesthetic whereas PESA, TESA and usually TESE only require a local anaesthetic. You will be admitted in the hospital on a day care basis and discharged after a couple of hours of the operation. There will be some minor bruising and swelling and a little discomfort for a few days after the procedure.

Sperm Collection, Use and Storage

The sperm collection itself will may be co-ordinated so that it coincides with your partner's egg recovery in the ICSI cycle, or if sufficient good quality sperm are retrieved, your sperm will be frozen in liquid nitrogen and can then be thawed out and used at any convenient time.

How do I begin the sperm retrieval and IVF / ICSI?

You can contact us by filling out a form or emailing us. We will get the opinion of the IVF specialist and send you a few medical tests list that she will need to opine on your case. We will also email you the profiles of egg donors to choose from. Once these medical tests are reviewed by her, we can plan for your ICSI cycle the next month or as per your schedule.



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