Surgical sperm retrieval procedures are used to help gather sperm from a man who would otherwise have difficulty producing it. Surgical sperm retrieval is one of a variety of fertility treatments and refers to a number of surgical methods used to obtain sperm from a man. In this procedure the sperm is removed from inside a man’s genitals. This is a method of retrieval of sperm for those who have little or no sperm present in their ejaculate. Once the sperm is removed it can be used in intracytoplasmic sperm injection procedures.
There are a number of different types of surgical sperm retrieval. Depending upon what is causing the lack of sperm in your semen, you may receive a different type of treatment. Some treatments are more effective than others. Overall effectiveness depends upon the type of fertilization method you choose to use in order to conceive. With most types of SSR, the sperm retrieved is immature and must be implanted using ICSI.
Vasal aspiration is an easy procedure requiring only local anesthetic. Those with an obstructed vas deferens or who have had a vasectomy within five years are candidates for this procedure. A syringe is inserted into the vas deferens and the liquid inside is removed. The vas deferens is massaged in order to produce more liquid. Recovery time is generally one day. This is the only SSR procedures that retrieve mature sperm.
Percutaneous Sperm Aspiration (PESA):
PESA is usually the first treatment option to pursue if you have no sperm in your semen. This procedure is short and relatively painless, as it requires no surgical cuts. A fine needle is inserted through the scrotum into the epididymis. Fluid is gently removed from the epididymis by aspirating it through the needle. This liquid is then analyzed for sperm content and motility. Usually, this procedure takes about 10 to 20 minutes and requires only local anesthetic.
Micro-epididymal Sperm Aspiration (MESA):
MESA is a microsurgical treatment that requires general anesthetic. Instead of using a needle, a small cut with a microsurgical tool is made through the scrotum and into the epididymis. Any fluid is then drained off and taken for microscopic examination.
Testicular Sperm Extraction (TESE):
If no sperm is found in the epididymal fluid, a needle is inserted into the testis. This needle removes a small sample of tissue, which is then examined for sperm. A variant of this procedure involves a small surgical incision in the testis, called a testicular biopsy. This procedure requires general anesthetic and will cause some pain and soreness. However, full recovery is usually expected within three days.
Surgical sperm retrieval is relatively risk-free. It is important, though, that you find a knowledgeable doctor who has performed these surgeries before. The main risks for these procedures include bleeding and infection but this occurs only in about 3% of patients. Any procedures that require anesthetic will also carry an increased risk of complications.
Effectiveness of Surgical Sperm Retrieval:
Surgical sperm retrieval has varying success rates depending upon which procedure you chose to have. Because the sperm taken from inside the body is not yet matured, it cannot successfully fertilize an egg using in vitro fertilization techniques. Only vassal aspiration produces sperm that are mature enough to be used with this method.
Instead, ICSI is the method of choice when using sperm obtained through SSR. PESA is associated with high retrieval rates – between 80% and 90% - and costs less than the other treatments. However, once an egg fertilized through ICSI is implanted by IVF, the pregnancy success rate is only about 26%.
MESA is associated with better pregnancy rates when used with ICSI. In fact, success rates are reportedly between 36% and 56%. TESE success rates are much lower. Only 60% of patients have sperm withdrawn using this method and only 20% become pregnant.
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