SSR may be used in isolation or may be combined with reconstructive procedures to re-establish ejaculation of sperm, such as vasectomy reversal and epididymo-vasostomy. The techniques of SSR we use are percutaneous epididymal sperm aspiration (PESA) or micro-epididymal sperm aspiration (MESA). With PESA and MESA the sperm is aspirated from the epididymis and with TESE, the sperm is extracted directly from the testis.
An SSR is usually planned in advance but in exceptional circumstances can also be carried out as an emergency procedure if the man is unable to produce a sperm sample on the day of his wife's or partner's egg collection. Under sedation and with pain relief a clinical team led by a KIMS doctor or nurse may use two different methods to surgically retrieve sperm:
- PESA is the least invasive method and involves inserting a fine needle into the epididymis, the convoluted tube that leaves the testis to become the vas deferens. This is particularly suitable for men who have had a vasectomy, or who were born without a vas deferens
- TESA involves passing the needle directly into the testis to remove a microscopic core of tissue, which is then prepared by scientists to release the developing sperm
- TESE involves the removal of some tissue from the testicle either by open operation (under sedation) or using a biopsy needle (general or local anesthetic). This tissue is then examined in the laboratory for the presence of sperm.
- Micro Epididymal Sperm Aspiration uses a small needle to aspirate relatively mature sperm from the epididymis and is suitable for patients who have a blockage or absence of the vas deferens. It is an open procedure and is therefore only attempted in theatres under general anaesthetic. Usually MESA is attempted at the same time as another procedure such as vasectomy reversal.
Samples are passed immediately to the KIMS laboratories where a scientist checks it for sperm suitable for use in ICSI. Once enough are identified, the procedure is stopped. Surgically retrieved sperm may be frozen, so the female patient may start her fertility treatment knowing that enough sperm is available to use with the ICSI procedure.
All SSR techniques are performed under a general anaesthetic, as a day case procedure, by our urologist and any sperm recovered is usually frozen before the IVF cycle commences so you know the viability of sperm available to achieve fertilisation. As the number of sperm collected by SSR is low, we recommend ICSI as the method of fertilising eggs retrieved during any subsequent IVF cycle.