For couples struggling with male factor infertility, where the male partner has difficulty producing or ejaculating sperm, surgical sperm extraction techniques offer a path to parenthood. These procedures, combined with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), have revolutionized the treatment of male infertility.  

What is Surgical Sperm Extraction?

Surgical sperm extraction involves retrieving sperm directly from the testicles or epididymis (the tube that stores and transports sperm). This is necessary when sperm are not present in the ejaculate due to blockages, low production, or other factors.  

Types of Surgical Sperm Extraction

• Testicular Sperm Extraction (TESE):A small incision is made in the testicle, and a tissue sample is removed to extract sperm. This technique is often used when sperm production is impaired.  
  • Microdissection TESE (MicroTESE):A more advanced form of TESE using an operating microscope to identify and extract sperm from specific tubules within the testicle. This increases the chances of finding healthy sperm.  
• Microsurgical Epididymal Sperm Aspiration (MESA):A small incision is made in the scrotum to access the epididymis. Fluid is aspirated from the epididymis, which is then examined for sperm. This technique is typically used when there’s a blockage preventing sperm from reaching the ejaculate.  

How it Works with IVF/ICSI

1. Sperm Retrieval:The surgical sperm extraction procedure is performed to obtain a sample of sperm.  
2. Egg Retrieval:The female partner undergoes ovarian stimulation and egg retrieval to collect mature eggs.  
3. Fertilization:In the laboratory, the retrieved sperm are used to fertilize the eggs through ICSI. This involves injecting a single sperm directly into each egg.  
4. Embryo Development:The fertilized eggs (embryos) are cultured in the laboratory for several days.  
5. Embryo Transfer:One or more embryos are transferred to the woman’s uterus with the aim of achieving pregnancy.  

Who Can Benefit from Surgical Sperm Extraction?

• Men with obstructive azoospermia:A blockage in the reproductive tract preventing sperm from reaching the ejaculate (e.g., after a vasectomy, infection, or congenital absence of the vas deferens).  
• Men with non-obstructive azoospermia:Impaired sperm production due to various factors (e.g., genetic conditions, hormonal imbalances, prior chemotherapy or radiation).  
• Men with very low sperm count or poor sperm motility:Where the chances of natural conception or success with conventional IVF are low.

Advantages of Surgical Sperm Extraction

• Enables biological fatherhood:Offers a chance for men with severe male factor infertility to have biological children.  
• High success rates:When combined with ICSI, surgical sperm extraction has good success rates for achieving fertilization and pregnancy.
• Minimally invasive:Most procedures are performed with small incisions and minimal discomfort.  
• Outpatient procedure:Patients typically go home the same day.

Considerations

• Surgical risks:As with any surgery, there are potential risks and complications, although these are generally rare.
• Emotional impact:Infertility and its treatment can be emotionally challenging for couples. Counseling and support groups can be helpful.
• Cost:Surgical sperm extraction and IVF/ICSI can be expensive, and insurance coverage may vary.  

If you’re struggling with male factor infertility, surgical sperm extraction may offer a solution. Consult with J. Matt Williams, MD our fertility specialist and urologist to discuss your options and determine if this approach is right for you.