AUA Summit - Sperm Retrieval: Treatment & Information


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What is Sperm Retrieval?

Sperm retrieval is any way used to get sperm for fertility purposes.

There are many ways to get sperm. The method used depends on why sperm aren't in the semen, what the patient wants, and the surgeon's skill.


What Happens under Normal Conditions?

At the base of the penis, sperm and testosterone (male hormone) are made in the scrotum's 2 testicles. The sperm leave the testicles through a coiled tube called the epididymis. They stay there until they're ready to be used. Each epididymis is linked to the prostate by a tube called the vas deferens. This tube runs from the scrotum into the groin, then the pelvis and behind the bladder. There, each vas deferens joins with a seminal vesicle and forms the ejaculatory duct. For ejaculation, sperm passes through the ejaculatory ducts to mix with fluid from the seminal vesicles, prostate, and other glands to form semen. The semen travels through the urethra and comes out the end of your penis.

When Is Sperm Retrieval Recommended?

Sperm retrieval is done when pregnancy is the goal but not possible without help. It is for men who have little or no sperm in the semen, or men who aren't able to ejaculate. In these cases, sperm can be collected from other parts of the reproductive tract. For good pregnancy rates, sperm retrieval is used with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

In vitro fertilization (IVF) is the process of combining an egg and sperm in a laboratory dish for fertilization. This combined sperm and egg are called an embryo. The embryo is transferred to the uterus for development.

Intracytoplasmic sperm injection (ICSI) is an IVF process where a single sperm is injected directly into an egg.

The way to check for sperm in the semen is to do a semen analysis. Your urologist will look at your semen under a microscope. No sperm in the semen (“azoospermia”) may mean sperm retrieval is needed.

The 2 main types of azoospermia are obstructive azoospermia and non-obstructive azoospermia.

Obstructive Azoospermia

With this condition, the testicles make sperm but a block in the male’s reproductive tract stops them from getting into semen. (This is how a vasectomy works. It is surgery to block the sperm from getting into semen.)

Sometimes there may be no vas deferens because of a birth defect. This can happen if you have the gene that causes cystic fibrosis. There might also be blocks in the epididymis and ejaculatory duct. Or, the vas deferens may have damage from a hernia repair or other surgery. Obstructive azoospermia may be surgically correctable.

Non-obstructive Azoospermia

With this condition, your body might not make sperm at all. Or the sperm might be made in such low levels that there aren’t enough of them to appear in the ejaculate. Blood hormone tests and genetic tests can help find the cause.

Some men have orgasms but no semen comes out of the penis. An orgasm is the physical experience that happens because of sexual stimulation. Ejaculation (release of semen) may occur when you reach orgasm. You may also have muscle contractions, an increased heart rate, breathing rate, blood pressure and sweating. Lack of visible semen with sexual stimulation may be due to anejaculation (lack of ejaculation) or retrograde ejaculation:

Anejaculation is when no seminal fluid reaches the urethra.

Retrograde ejaculation is when semen gets into the urethra but flows the wrong way. Instead of going out through the penis, the semen is pushed back into the bladder. This doesn’t hurt the body, but it can cause infertility.

Anejaculation or retrograde ejaculation can be caused by injuries, medical or surgical conditions. Some of these are:

  • Spinal cord injury
  • Advanced diabetes
  • Multiple sclerosis
  • Psychological issues
  • Pelvic surgery

Your urologist can diagnose these conditions by checking your urine for sperm after an orgasm. If healthy sperm can’t be released naturally, sperm retrieval may be needed.


Non-surgical Sperm Retrieval

If you have anejaculation or retrograde ejaculation, ejaculation can be induced. Then the semen is collected.

Two methods are:

Penile Vibratory Stimulation (PVS)

PVS is done with a special vibrator placed at the tip of the penis. This stimulation can cause an ejaculation.

Electroejaculation (EEJ)

EEJ is done with a probe that sends electrical energy to the prostate and seminal vesicle. EEJ may be done in the urologist's office for men with nerve injuries and no feeling. But for men who have normal sensation, general anesthesia is needed. General anesthesia is used to prevent pain during this EEJ procedure. It makes you unconscious. You do not feel any pain, and you do not remember the procedure afterwards.

If PVS or EEJ don't work, a sperm retrieval method from the epididymis or testicle may be needed.

Testis Sperm Retrieval

There are many ways to get sperm from the reproductive tract. The goal is to get the best quality and number of sperm. Care is taken not to harm the reproductive tract. This will allow future sperm retrieval or reconstruction, if needed.

Some of these procedures are:

Testicular Sperm Extraction (TESE)

TESE is often used to diagnose the cause of azoospermia. It can also get enough tissue for sperm extraction. The sperm can be used fresh or frozen (“cryopreserved”). TESE is often done in the urologist's office with a nerve block. A nerve block is an anesthetic injected into nerves to treat pain. The nerve block will "turn off" a pain signal from a specific location; in this case, from the testis. Or, TESE can be done under anesthesia in a surgical center. It involves one or several small cuts in the testes.

Testicular Sperm Aspiration (TESA)

TESA is also sometimes called Testicular Fine Needle Aspiration (TFNA). TESA can be used to diagnose or treat azoospermia. It can also be used to collect sperm from the testicles. It's often done with a nerve block in the Urologist's office or the operating room. A thin needle punctures the skin and testis to gently pull out sperm. No other cuts are needed.

TESA with Mapping

This is where TESA is done with many needle aspirations spread throughout the testes. Aspiration is a medical procedure used to remove tissue samples. Some physicians feel this method is comparable to TESE at recovering sperm. TESA is sometimes used for patients with non-obstructive azoospermia.

Microsurgical Epididymal Sperm Aspiration (MESA)

MESA uses a surgical microscope to help retrieve sperm from the epididymis tubes. MESA can retrieve lots of healthy sperm that can be saved and frozen for later. This method is very safe. However, it calls for general anesthesia and a highly skilled micro-surgeon.

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA, like TESA, can be done many times at low cost and without a surgical cut and is especially suited for obstructive azoospermia. It doesn't need a high-powered microscope, so more urologists can do it. PESA is done under local or general anesthesia. The urologist sticks a needle attached to a syringe into the epididymis to gently remove fluid. Sperm may not always come out this way. Sometimes a surgical process is needed.

Microsurgical Testicular Sperm Extraction (Micro-TESE)

Micro-TESE is done only for non-obstructive azoospermia. The outer cover of the testicle is opened and the inside is checked. Your urologist can see areas more likely to be making sperm. This technique is done by a Urologist trained in microsurgery. Micro-TESE is usually done in the operating room. This way, more of the testis is examined, but less tissue is removed. There's also less damage to the blood vessels. Some feel Micro-TESE offers a better chance of finding sperm in the patient with non-obstructive azoospermia.

After Treatment

Recovery after testicular or epididymal sperm retrieval depends on the method used. Recovery time can range from a few days to a week.

Most men will be told to avoid strenuous activity. You might use a jockstrap until you’ve fully recovered. Ice packs help right after the surgery. Your urologist will prescribe medicine to help with pain. You may also be given antibiotics to take before and/or after sperm retrieval to lower the risk of infection. If you have stitches, you will need more time to heal. Most men can return to office work in 24 to 48 hours. It may take 5 to 10 days to return to heavy work.

Possible problems can include:

  • Bleeding
  • Infection
  • Pain
  • The chance of not finding sperm
  • The need for future procedures
  • Testicular injury or loss (these are rare)

Frequently Asked Questions

How long does sperm retrieval take?

Retrieval time depends on:

  • The cause of the azoospermia
  • The technique used
  • How soon sperm are found

The procedure can take anywhere from minutes to hours.

How much does a sperm retrieval cost?

The cost of sperm retrieval depends on a number of things. Some of these are:

  • Type of procedure
  • Where the procedure is done (office or operating room)
  • How long the procedure takes
  • Whether sperm are being used fresh or will be frozen for later use

Procedures done in the office under local anesthesia avoid surgical center or anesthesia costs.

What happens if no sperm are found?

It's rare to not find any sperm in cases of obstructive azoospermia.

With non-obstructive azoospermia, sperm may not be retrieved in 20% to 80% of cases. This depends on what caused the non-obstructive azoospermia.

There's always a chance that no sperm will be found. This can be emotionally draining for you and your partner. Couples should discuss this possibility with each other and their doctors before the procedure.

One option is to use donor sperm as backup for IVF/ICSI. The decision to use donor sperm is very personal. Couples should talk about it and prepare for it before surgery. If using donor sperm isn't an option and no sperm are retrieved, you may think about adopting a child.

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