When azoospermia is repeatedly ascertained and no sperms are detected in the ejaculate or there is a complete lack of semen (aspermia) or ejaculation, sperms may be retrieved and used for fertilisation with the aid of TESE and MESA. Both methods involve microsurgical procedures, during which the urologist surgically retrieves sperms directly from the tubules in the head of the epididymis and from the testicular tissue. The procedure is performed under general anaesthesia and it takes approximately one hour. A part of the retrieved sperms is usually used immediately to fertilise the eggs. We recommend to cryopreserve the remaining part for later use should additional IVF cycles prove necessary. As the sperms are quite scarce and are often retrieved in a very small number, immature and with very limited motility, ICSI is strictly used to fertilise the eggs.

Microsurgical Epididymal Sperm Aspiration (MESA)

During this microsurgical method, a needle is used to aspirate the fluid from the epididymal tubules where sperms mature. The fluid may contain mature sperms. The procedure is usually performed under general anaesthesia. An approximately 3 cm long incision is made on the scrotum to enable access to the epididymis and epididymal fluid is aspirated from the tubules.

Testicular Sperm Extraction (TESA)

This microsurgical procedure is performed under general anaesthesia and involves the opening of the scrotum by an approximately 3 cm long incision and the taking of small segments of testicular tissue from small incisions on the testicle surface. Sperms are subsequently extracted from the tissue in the laboratory.

The success rate of sperm retrieval ranges between 60 to 80% depending on the cause of azoospermia.