Microscopic sperm retrieval surgery

Sperm retrieval is a method utilised to harvest sperm from the testis for IVF purpose.

 

There are several methods to harvest the sperm ranging from simple aspiration (such as PESA) to surgical sperm retrieval procedures (TESE and microTESE) depending on the semen analysis, previous testicular biopsy and underlying testicular dysfunction.

1. Epididymal sperm aspiration (PESA)

2. Testicular sperm extraction (TESE)

3. Microsurgical testicular sperm extraction (microTESE)

While PESA is a simpler procedure to perform, if the quality of sperm obtained is poor and unsuitable for IVF treatment, TESE is often carried out to harvest the sperm directly from the testis in order to obtain better sperm.
Microsurgical TESE is a complex and time-consuming process performed under microscopic magnification using microscopic surgical tools, to localise viable sperm among the testicular tubules when no sperm is found despite random testicular tissue harvest. Microsurgical TESE (microTESE) is the last method of ensuring your paternity for assisted reproductive technology and IVF. If no sperm (or poor quality sperm) is found in one testis, the other testis will also be explored under microscope. However, there is no guarantee that microTESE can always find sperm so a back-up plan (such as sperm donor) should be considered.

 

 

Professor Chung has published extensively on male reproductive surgery and is considered the leading microscopic male fertility surgeon expert in Australia and Asia-Pacific. He is the first urologist in Australia to receive a formal fellowship training in Andrology that is accredited by the Sexual Medicine Society of North America, and the past Chair of the Andrology section for the Urological Society of Australia and New Zealand. He has mentored many surgeons over the years including being invited as surgeon expert and organised numerous surgical workshops around the world.

What preparation is required?

Both PESA and TESE can be performed under local anaesthesia. Professor Chung will liaise with your chosen IVF unit to coordinate your sperm retrieval surgery with your partner’s egg pick-up. Microsurgical TESE is performed under general anaesthesia and therefore you should be fasted (nothing to eat or drink) for 6 hours prior to surgery. It is recommended that you avoid sexual activity (including ejaculation) for 5 days before your surgery. Regular medications can be taken with a sip of water with the exception of blood thinning agents (such as warfarin, clopidogrel) or non-steroidal anti-inflammatory drugs which need to be stopped for 7-10 days.

What happens in the operating room?

Your procedure will be performed under local or general anaesthesia depending on the types of surgery and appropriate anti-microbial cover will be given.

What are the risks?

Sperm retrieval surgeries when performed by an expert surgeon, is considered a safe procedure with minimal complications. Some of the common postoperative complaints include

  • Pain
  • Swelling
  • Bruising, bleeding or hematoma
  • Skin irritation or wound issue (mild infection)
  • Testicular infection and injury

What to expect afterwards?

Professor Chung will discuss with you whether sperm is found during surgery but the final result will be confirmed by the IVF scientist. You are usually discharged the same day and you can remove the surgical dressing and shower the next day. You may be discharged with prophylactic oral antibiotics. Most men return to normal work after a few days. However, you should avoid strenuous physical exertion or sexual activity for 4-6 weeks.

Follow-up

You will have a follow-up appointment with Professor Chung scheduled at 2-4 weeks postoperatively.