Infertility in some men may be due to an interruption in the sperm transport passages as a result of either a previous male sterilization operation (vasectomy), an anatomical birth abnormality (absence of the vas deferens), or a spinal/pelvic injury or operation.
In these cases sperm may need to be surgically collected from inside a man’s genitals instead of waiting for the sperm to be ejaculated out. The sperm requirement for egg fertilization has dropped from hundreds of thousands for in vitro fertilization (IVF), to one viable sperm required for ICSI when combined with IVF. Sperm can be aspirated with a needle from the testicle or from the vas deferens (the tube that carries the sperm from the testicle).
The procedure
The man is given some drugs to sedate him and some local anesthesia is also used to numb the area. Then a small needle is inserted and sperm is aspirated. There should be no severe pain. The procedure generally takes about 30 minutes.
There are several different methods used to retrieve sperm surgically:
- Vasal aspiration
- Percutaneous sperm aspiration (PESA)
- Microepididymal sperm aspiration (MESA)
- Testicular biopsy
The sperm can be used fresh if it is obtained on the same day that the eggs are obtained from the woman, or it can be frozen and then thawed and used later. Usually enough sperm is aspirated so that it can be split up into several vials and multiple attempts of IVF can be performed if that will be necessary.
The sperm aspiration procedure is performed by a urologist or a reproductive endocrinologist (infertility specialist).
Candidates
Surgical sperm retrieval is not for every man. In general, those men who are experiencing infertility due to one of the following reasons may be able to use SSR in combination with ICSI and IVF in order to produce a pregnancy:
- Blockage in the vas deferens or epididymis
- Congenital absence of the vas deferens (CAVD)
- Sperm production difficulties
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