Men who have previously had a vasectomy will require a vasectomy reversal, or retrieval of sperm and ICSI, to conceive. Occasionally, some men may have very severe forms of infertility, with a complete absence of sperm in the ejaculate. In these instances, it is not possible to conceive without assisted reproductive technology (ART), or the use of donated sperm. Additionally, these patients will require a procedure to retrieve sperm in order to conceive using their own sperm.
In patients with a previous vasectomy, retrieval of sperm is almost always successful. In patients who do not have sperm in their ejaculate for other reasons, an attempt may be made to retrieve sperm from various points along the male reproductive tract, including the testes. This is successful approximately 50% of the time.
The different types of sperm retrieval are percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE).
Percutaneous Epididymal Sperm Aspiration (PESA)
Percutaneous epididymal sperm aspiration (PESA) is a procedure that is performed as a day procedure under local anesthesia. This is commonly used to retrieve sperm in individuals who do not have sperm in their ejaculate due to a blockage, including men with a previous vasectomy. This procedure involves placing a small needle into the epidydimis and aspirating sperm. The procedure often takes only a few minutes, providing sperm that can be frozen for later use.
Testicular Sperm Extraction (TESE)
Testicular sperm extraction (TESE) is a procedure that is performed under general anesthesia, or occasionally light sedation. This procedure is often performed in individuals who did not have any sperm identified during a PESA procedure, or in individuals who do not have sperm in their ejaculate. A small incision is made in the skin and connective tissue overlying the testicle, and a small amount of tissue removed from the testicle. This tissue is examined under the microscope to isolate sperm for use in a future ICSI cycle. Occasionally, sperm cannot be found in the testicle, and other treatment options (such as donor sperm) may be offered.