Surgical Sperm Retrieval FAQ

What is Surgical Sperm Retrieval (SSR)?

SSR is a technique for collecting sperm from a man’s testicles. It is a minor procedure, carried out under local anaesthetic or as a day case under heavy sedation.

Who needs SSR?

SSR is intended to help men who have no sperm in their ejaculate. This can be the result of several causes: a blockage in the vas deferens (the tube which carries the sperm to the penis); an absent vas deferens; or a blockage in the epididymis, (the structure connecting the testis to the vas deferens.) Most of these men produce healthy sperm in the testicles which can be retrieved by SSR. Unfortunately, some men have testicles that fail to produce any sperm at all (this is called primary testicular failure) and SSR is not a suitable procedure for this condition.

What are the types of SSR? How you chose the procedure?

There are a few different types of SSR, and the cause of the sperm problem will determine which procedure is most suitable for you. With P4 Fertility, the most suitable method for you would be discussed based on your reports. PESA (Percutaneous Epididymal Sperm Aspiration) PESA is a short, relatively painless procedure and requires no surgical incisions. A fine needle is inserted into the epididymis through the scrotum and fluid aspirated. This fluid is then inspected under a microscope for sperm count and motility. The procedure takes about 15-20 minutes. TESA (Testicular Sperm Aspiration) TESA is performed if no sperm are found in the epididymal fluid. This is a short, relatively painless procedure and requires no surgical incisions. A fine needle is inserted into the testes and tissue aspirated is then examined for sperm similar to PESA procedure. TESE / Testicular biopsy is performed if no sperm are found in the PESA and TESA procedure. A small incision is made into the testis itself. A small sample of testicular tissue is taken which is examined for sperm. This procedure will cause some pain and tenderness; however, full recovery is expected within a few days. If necessary, the tissue will be sent to the histology laboratory to obtain full biopsy report.

How effective is surgical sperm retrieval for ICSI /IVF?

The sperm retrieved are used on the same day if it is a fresh cycle of IVF / ICSI or sperm can be frozen. The freezing process does not affect the ability of the sperm to subsequently fertilise an egg. However, the sperm retrieved are usually low in numbers, may not be mature and therefore cannot successfully fertilise an egg using standard IVF (In Vitro Fertilisation) technique. Because of this, the embryologist will pick out a single sperm to inject into each egg and this procedure is called ICSI (Intra Cytoplasmic Sperm Injection). It is also possible that no sperm at all will be obtained.

What risks are involved?

SSR is a relatively low-risk procedure. Possible complications include bruises, haematoma (collection of blood in testis), infection and anaesthetic risks. Anaesthetic side effects include postoperative nausea and vomiting (usually, last for 1-2 hours and can be controlled with medications), postoperative shivering, chest infection (very rare with sedation anaesthesia), awareness (becoming conscious during some part of operation; most patients who are aware do not feel any pain, but may have memories of events in the operating theatre), allergic reaction to the anaesthetic, very rarely anaphylaxis (risk is 1 in 10,000), risk of death or brain damage during anaesthesia (in general the risk is 1 in 100,000 but should be even rarer in sedation for minor procedures such as SSR. After your procedure o Please wear reasonably tight-fitting underpants rather than boxer shorts after your procedure. This will provide some support to your scrotum. o Showering is preferable to sitting in hot baths to prevent infection. o Sexual activity is NOT advised for a week after the procedure.