SURGICAL SPERM RETRIEVAL What is Surgical Sperm Retrieval? This is a procedure whereby sperm is extracted directly from the testes. The procedure is for men undergoing fertility treatment who cannot ejaculate sperm, a condition known as Azoospermia. There are two major categories of Azoospermia: Obstructive or Non‐Obstructive (Testicular Failure). In Obstructive Azoospermia, sperm is produced by the testes, but is not ejaculated because of the blockage or absence of the vas deferens (men born without the tube that drains the sperm from the epididymis). The man can still ejaculate seminal fluid but this fluid will not contain any sperm. It is possible to collect sperm directly from the epididymis or testes. An obstruction preventing sperm release may be due to: Injury Infection Congenital absence of the vas deferens. Vasectomy, which is an operation used to prevent pregnancy. Non‐Obstructive Azoospermia ‐ the testicles are not producing sperm or they are producing such low counts of sperm that they don’t reach the vas deferens. Techniques There are different techniques of surgical sperm retrieval: Percutaneous Epididymal Sperm Aspiration (PESA) PESA is the collection of sperm through a fine needle directly from the epididymis, where sperm is stored, after it is formed in the testes. This procedure requires local anesthesia. Testicular Sperm Aspiration (TESA) TESA is used to obtain viable sperm from a testicle. A small incision is made in the scrotal skin and then a spring‐loaded needle is gently inserted into the testicle. Testicular Sperm Extraction (TESE) TESE is the collection of sperm from a biopsy or several biopsies from the testicular tissue after making a small incision in the scrotal skin. TESE is carried out under local anaesthesia. It requires only about 60‐90 minutes of hospital stay. The tissue collected will be examined for sperm. Sperm recovered will be used for treatment using ICSI technique and the remaining tissue or sperm may be frozen and placed in storage for future use. Microepididymal Sperm Aspiration (MESA) In MESA, the epididymis (organ above the testicle where sperm is stored) is isolated through an incision made in the scrotal skin. An operating microscope is used to examine the very small tubules of the epididymis that contain the sperm. A dilated tubule is opened and the fluid is collected and examined for the presence and quality of sperm for ICSI. This procedure requires general anaesthesia in an operating room equipped with an operating microscope. Microdissection Testicular Sperm Extraction (Microdissection TESE) Microdissection TESE is a procedure performed for men who have a sperm production problem and are azoospermic. Microdissection TESE is performed in the operating room with general anesthesia under an operating microscope. We offer TESE, PESA and TESA. Preparing for treatment • You need to give written consent and you will be required to give a separate written consent if you want any sperm /testicular tissue frozen. • You will be admitted in the morning of your wife/partner’s oocyte (egg) retrieval day. • Stop taking Aspirin and related drugs because they increase the risk of bleeding during the procedure. • A light meal on the morning of the procedure is recommended. What should I expect after the treatment? • You will be informed if we find sperm or not. • You will rest in the clinic for about 60 minutes after the procedure and the doctor will let you know when to go home. • You will be advised to avoid strenuous activates and wear scrotal or athletic support in the immediate period after the surgery for a week. • You will be given oral pain relief medication and antibiotics to prevent infection; An ice pack provides soothing relief in the immediate post‐operative period. • You can return to normal office work in 48 hours and full strenuous activities in two weeks. Keep the wound clean by having your bath every day. • There should be no intercourse for two weeks after the procedure. You might notice some blood when you ejaculate the first time after the procedure but this is normal. • Full recovery ranges from a few days to a couple of weeks depending on the technique that is used; with TESE recovery takes a few weeks. • It may take between 6 and 8 weeks before the stitches completely dissolve. Are there risks associated with the procedure? This procedure is very safe. However, the following risks may be associated with the procedure: • Pain after the procedure • Infection in less than 1% of cases • Bleeding in less than 1% of cases • Scrotal swelling, which may last up to 3months. It is just hard and painless • The procedure may yield no sperm; failure to obtain sperm is uncommon in cases of obstructive azoospermia. In non‐obstructive azoospermia, failure to retrieve sperm occurs in 20‐80% of cases depending on the associated condition. What happens if no sperm is found? Failure to find sperm can be catastrophic emotionally to both the man and his partner. We usually counsel couples to discuss this thoroughly with each other and their doctor well in advance of the procedure. If the procedure yields no sperm, one option is to use donor sperm as backup for assisted reproductive technologies such as IVF/ICSI. The decision to use donor sperm is a very personal one that the individual couple needs to address and prepare for PRIOR to surgery. If the use of donor sperm is not an option for the couple, then adoption remains a viable option for family planning.

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