Sperm retrieval surgeries

Sperm retrieval is a method utilised to harvest sperm from the testis for IVF purposes. There are several methods to harvest the sperm ranging from simple aspiration to microsurgical sperm retrieval procedures depending on the semen analysis and underlying testicular dysfunction.

1. Epididymal sperm aspiration (PESA)

2. Testicular sperm aspiration (TESA) or biopsy/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 (microdissection) 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 (TESE). Indeed microsurgical TESE is considered the standard of care in sperm retrieval technology for men with no sperm count and is the last method of ensuring your paternity for assisted reproductive technology (IVF therapy).
 

What preparation is required?

Both PESA and TESE can be performed under local anaesthesia. However microsurgical TESE is performed under general anaesthesia and therefore you should have nothing to eat or drink for 6 hours prior to surgery. Regular medications can be taken with a sip of water with the exception of blood thinning agents (eg. warfarin, aspirin, clopidogrel) or non-steroidal anti-inflammatories which need to be stopped for 7-10 days. A mid-stream urine (MSU) test may be necessary for some patients.

What do I need to bring to surgery?

• Your usual medications

What happens in the operating room?

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

What are the risks?

Sperm retrieval surgeries when performed by an expert surgeon, are considered a safe procedure. Some of the common postoperative complaints include:

• Pain
• Swelling
• Bruising or hematoma
• Skin irritation or mild infection

What to expect afterwards?

You are usually discharged the same day and you can remove the surgical dressing and shower the next day. You will be discharged with 5-7 days of oral antibiotics. Most men return to normal work after a few days. However, you should avoid strenuous physical exertion or sexual activity for 6 weeks.

Follow-up

You will have a follow-up appointment with Prof. Chung scheduled at 6 weeks postoperatively.