Sperm Retrieval Procedures: What You Need to Know About TESE, PESA, and Micro-TESE

Key Takeaways

Sperm retrieval procedures are done when a couple is facing family building challenges due to male factor infertility. There are many factors that influence male fertility and typically, low sperm parameters largely contribute to male infertility. Sperm parameters include sperm concentration, sperm motility and sperm structure. Other times, there could be challenges with the chromosomes in the sperm cells which could result in loss of pregnancy repeatedly. 

Sperm retrieval procedures are done when a person’s sperm parameters are too low for natural conception. Sperm retrieved is thus used to facilitate pregnancy through assisted reproduction technologies (ART). This article will be discussing the types of sperm retrieval, eligibility for sperm retrieval, how the procedures work as well as the fertility treatments for which sperm retrieval is required. 

Types of Sperm Retrieval Techniques

There are several ways in which sperm can be retrieved, and this is determined on a case by case basis. Let us look at these briefly. 

Testicular Sperm Extraction (TESE)

This procedure is done under local anesthesia or in the operating room under full sedation. The sperms are retrieved directly from within the testicular tissue. It is performed when a man does not have sperm in their semen when they ejaculate. It is usually coordinated with the egg retrieval procedure for the female.

Microdissection Testicular Sperm Extraction (Micro-TESE)

This is a more advanced version of the TESE procedure. It provides for more optimal sperm retrieval and is done under sedation. As well, it is usually performed a day before the female partner’s eggs are retrieved, allowing for each partner to be there for the other’s procedure. 

Percutaneous Epididymal Sperm Aspiration (PESA): 

This procedure is done in cases where a man does not have any sperm in his ejaculate due to obstruction. Obstruction can be as a result of infection or surgical procedures. Sperm retrieved in this way are obtained directly from the epididymis. It is also coordinated with the female partner’s egg retrieval procedure. 

Microsurgical Epididymal Sperm Aspiration (MESA)

This procedure is performed where a man’s ejaculate contains no semen due to obstruction or absence of sperm/semen transportation tubes such as the vas deferens. It is done under sedation using a surgical microscope and is usually timed with the egg retrieval procedure of the female. This method has been found to be highly effective in retrieving a larger quantity of mature sperm. 

Who Needs Sperm Retrieval? 

The typical application of sperm retrieval is for patients who have no sperm in their semen upon ejaculation. This could have several causes which we shall look into below: 

Azoospermia

Non-obstructive azoospermia is whereby the genital tract and testicles are healthy, but there is insufficiency in hormonal stimulation to cause the production of sperm. Sometimes, the issue is that the testes themselves are poorly developed or abnormal and therefore no sperm production occurs within. 

Obstructive azoospermia is whereby the testicles are healthy and well formed but for one reason or other, the genital tract has blockage. Blockage prevents the sperm from traveling outside the body during ejaculation. The typical cause of blockage is due to infection. However at times a vasectomy could be the cause. 

Failed Vasectomy Reversal

As mentioned, vasectomies cause blockage in the genital tract. The procedure itself is an intentional blocking of the genital tract to prevent sperm from being ejaculated during sex, resulting in pregnancy. However, vasectomies are typically reversible, but when the reversal procedure is not successful, it could result in the genital tract being blocked more permanently. 

Genetic Conditions

Studies have shown that some cases of azoospermia are as a result of genetic conditions such as anomalies in the chromosomes, epigenetic disorders, multifactorial genetic diseases and monogenic disorders. Genetic testing is vital in order to understand the causes as well as prevent the passion on of genetic conditions to offspring. 

How the Procedure Works and Recovery Time

Sperm retrieval procedures are determined based on sperm mapping. This is a minimally invasive procedure that allows professional medical practitioners to determine the most ideal locations to retrieve sperm from. Typically sperm can be retrieved from several locations namely, the vas deferens, the epididymis, directly from the testicles, or the ejaculatory tract. 

The goal of sperm retrieval is to retrieve a good number of viable sperm, taking great care not to damage the testicle tissues. Once sperm is successfully retrieved, recovery time could range from a few days to about a week. As well, a patient may experience discomfort, swelling or bruising after the procedure. Therefore a patient is required to rest, avoiding activities such as driving or other physical activities.  

Success Rates with IVF & ICSI

Sperm retrieval procedures are typically done in order to be applied to assisted reproductive technologies (ART). The success rates between IVF and ICSI vary, with the latter showing even higher success rates than the former. The reason for this has to do with the way in which the fertilization is done it the lab. With conventional in vitro fertilization (c-IVF), the female egg is placed into a petri dish, and several sperm are placed around the egg. The sperm then have to swim toward the egg to fertilize it. While this continues to be successful, ICSI takes a more direct approach.

With intracytoplasmic sperm injection (ICSI), the sperm is injected directly into the cytoplasm of the egg which results in a more direct fertilization process. This is an approach that is gaining popularity not only among couples faced with male factor infertility, but also among other patients undergoing IVF treatments, who are not necessarily faced with male infertility.

What to Expect at San Diego Fertility Center

The team at San Diego Fertility come with a wealth of expertise in the management of male factor infertility. By using the latest technologies for accurate diagnostics and treatments, each patient is given the care that is best suited to their circumstances. As well, with their patients’ family building goals in mind, each treatment plan is curated toward higher success and more positive outcomes. If you would like to speak to a professional healthcare provider regarding your fertility and family building goals, contact us today. 

FAQs:

What foods improve sperm health?

Sperm health can be greatly improved by including foods that are rich in antioxidants, omega-3s, zinc, and folic acid. Some of these are nuts, fish, dark leafy greens, and citrus fruits.

How does smoking and alcohol affect sperm?

Yes. Both alcohol and tobacco or nicotine based products have an impact on sperm. Smoking has been known to lower sperm count and motility, while excessive alcohol can lower testosterone levels and overall sperm production.

Does heat exposure really affect sperm?

Absolutely, yes! When a person’s testicles are exposed to heat over a prolonged period of time, such as time spent in saunas or hot tubs. As well as working with laptops directly on one’s laps could reduce sperm production in the testicles. 

Can stress impact fertility?

While stress is a part of life, high levels of stress could be harmful. High stress levels increase the levels of cortisol in the bloodstream, which can lower the production of testosterone and impact sperm production.

What vitamins and supplements help improve sperm?

Supplements and natural sources of Vitamin C, Vitamin D, Zinc, Coenzyme Q10, and Folate have been shown to improve both the concentration and quality of sperm one produces.

This blog is for informational purposes only and should not be considered medical advice.  Please consult with your physician or a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment.