Getting Pregnant and Assisted Reproduction: Surgical Sperm Retrieval
This treatment is generally recommended in instances when a very low sperm count or an absence of sperm in semen is the cause of male infertility. There are a number of techniques used to collect sperm in this type of male infertility treatment, which can later be used in conjunction with other types of assisted reproduction procedures in order to be successful in getting pregnant.
What is Surgical Sperm Retrieval?
Sperm retrieval is a broad term that encompasses a variety of surgical techniques used to obtain sperm. This can be contrasted to other procedures in which sperm is obtained after ejaculation. The surgery is designed to help men who have extremely low or absent sperm levels in semen, a cause of male infertility that affects approximately 10% of all infertile men.
Due to the fact that there is a low or absent sperm count in a manï¿½s ejaculate, it is necessary to extract sperm from the vas deferens, epididymis or testicles.
How Does Surgical Sperm Retrieval Help Treat Male Infertility?
Sperm retrieval is a male infertility treatment that is most effective in cases when one of the following male infertility causes is affecting a coupleï¿½s chances of getting pregnant:
- blockage in the vas deferens or the epididymis
- congenital absence of vas deferens (CAVD)
- sperm production difficulties
Types of Surgical Sperm Retrieval
There are different methods of surgical sperm retrieval options available in order to remove sperm from inside of the genital tract. The type of surgical sperm retrieval a man undergoes depends on why sperm is absent from the ejaculate.
All types of SSR procedures are considered to be minor surgeries and generally require a local anaesthetic as well as a recovery period of only a few days.
- percutaneous sperm aspiration (PESA): this type of surgery is most suitable for when male infertility is caused by the congenital absence of vas deferens or by the presence of scar tissue. It is generally used when no sperm is present. This sperm retrieval procedure does not require surgery. The procedure is performed under the administration of a local anaesthetic and usually takes 20 minutes. In PESA, a needle is inserted through the scrotum via the epididymis in order to remove liquid from inside. Doctors seek to collect 10 to 20 million sperm in sperm retrieval, meaning that multiple aspirations in one or both testicles are necessary. Sperm removed from the epididymis in one or both sperm are not yet mature, meaning that the use of ICSI is necessary in order to fertilize an egg in order for pregnancy to occur.
- vasal aspiration: this infertility treatment is used when the vas deferens is blocked or in cases when a vasectomy was performed within the last five years. Vasal aspiration is the only type of surgical sperm retrieval that is able to retrieve mature sperm, as the sperm removed in this procedure has travelled through the epididymis. This type of procedure requires the use of a local anesthetic; a needle is then inserted into the vas deferens and is then massaged to produce additional liquid before being removed. The extracted sperm is then prepared for IVF. Because mature sperm is collected, it can also be cryogenically preserved for future use, in addition to being used in conjunction with ICSI.
- micro-epididymal sperm aspiration: while similar to PESA, this form of sperm retrieval requires that a tiny incision be made through the scrotum and into the epididymis. Fluid found in the epididymal tube is drained and then analyzed for the presence of sperm. This type of male infertility treatment procedure is performed under a general anaesthetic and is used to treat men who have scar tissue present on the vas deferens, or for men who do not have a vas deferens.
- testicular sperm extraction (TESE): best suited in cases when the cause of male infertility is due to a blockage in the epididymis that is found close to the testicles, thereby preventing sperm from entering into the epididymis. It is also used to treat male infertility problems when a blockage in the testicles or when sperm count is low enough so that sperm cannot reach the ejaculate is preventing a couple from successfully getting pregnant. In this surgical male infertility treatment procedure, immature sperm is removed directly from the testicles through a testicular biopsy, which removes some testicular tissue. A local anesthetic is administered and a small incision is made in order to remove tissue. A similar procedure is testicular sperm aspiration (TESA), however instead of an incision, this sperm retrieval process uses a needle to collect sperm. Because sperm collected is immature, this procedure requires ICSI in order to fertilize eggs for pregnancy to occur.
Surgical Sperm Removal Success Rates
The rate of success associated with sperm removal depends on the type of procedure used.
PESA has the highest rate of success in the retrieval of sperm, 80 to 90% while TESE has a sperm retrieval success rate of 60%.
Depending on the type of surgery, sperm removal is linked to a pregnancy success rate of approximately 20 to 30%. MESA is linked to a higher pregnancy rate when used in conjunction with ICSI, between approximately between 36% and 56%. TESE is linked to a 20% rate of pregnancy success while PESA is linked to a pregnancy success rate of about 26%.
There are no major risks associated with surgical sperm retrieval. The main risks linked with this type of surgery can include bleeding and infection, however, this is quite rare and occurs in approximately 3% of patients. Any procedure that requires an anesthetic will carry an increased risk of complications.
Another concern linked with SSR is the fact that immature sperm are often retrieved. Some experts have expressed concern regarding the use of sperm cells that have not yet fully evolved in order to achieve pregnancy, as is the case with TESE. In some cases, spermatids (round cells that have yet to mature into sperm with tails) may be removed through testicular sperm extraction. While spermatids may be used in conjunction with ICSI to achieve pregnancy, this procedure is still considered to be in its experimental stages.
Before deciding SSR, be sure to consult with your fertility doctor about the benefits and risks associated with this procedure for you. You should also discuss secondary treatment options in case it is not possible to remove enough sperm through this procedure.
The average cost of surgical sperm retrieval ranges from between £1500 and £3000, excluding the costs of IVF and/or ICSI.
Get the support you need for your fertility treatment concerns here in our forum.