One to two percent of men who have been diagnosed with infertility will have complete absence of sperm in the ejaculate called azoospermia.
In some of these men, the sperm production is normal, but there is a blockage which prevents the sperm from entering the semen. This can be the result of a blockage in the tubes that carry the sperm, a failure of the sperm passages to develop, or a previous vasectomy/failed vasectomy reversal procedure. In others, there is a problem with the sperm production itself, known as non-obstructive azoospermia or testicular failure. There are many reasons why the sperm production may be affected; infections. undescended testes, injury or genetic causes.
Surgical sperm recovery (SSR) techniques are now routinely available, which allow the sperm to be removed directly from the epididymis (collecting tube) or the testicle. The sperm thus collected is then used to fertilise the eggs using the ICSI procedure.
There are two main techniques, which are performed under sedation and local anaesthesia:
Percutaneous Epididymal Sperm Aspiration (PESA)
Under sedation, a small needle is passed into the epididymis and sperm is recovered. This is the main procedure used in obstructive cases of azoospermia. Sufficient sperm is recovered for several cases of ICSI.
Testicular Sperm Extraction (TESE)
This is mainly used in testicular failure cases, where multiple biopsies are obtained from the testes using an open procedure. The testicular tissue is processed within the laboratory and sperm extracted.
An alternative to surgical sperm recovery is to use donated sperm.