Dr Gayatri Satpathy

Surgical sperm

As many as 10% to 15% of infertile men have no sperm in their ejaculate (the fluid released from the penis during orgasm). This is called azoospermia. Forty percent of cases are due to a blockage (obstruction) in the reproductive tract. Problems with sperm production account for the rest.

ICSI has made it possible for most men with azoospermia or severe male factor infertility to have their own biological children. As even in cases where very few sperms were retrieved the eggs can be fertilized using ICSI technique.

Surgical Sperm Retrieval is a surgical procedure performed as a day care surgery under General/ Local anesthesia where the sperms of male partner are collected directly from the epididymis or the testis for use in IUI or IVF/ ICSI. This is done when sperms are not obtained in the ejaculated semen sample of the male partner. There are different procedures carried according to the patient’s requirement.

Who require surgical sperm retrieval?

  • Men who do not have sperms in the ejaculate semen
  • Men who have semen with high DNA Fragmentation Index
  • Men who do not produce ejaculate due to obstruction from injury or infection
  • Men who fail to produce an ejaculate due to erectile/ ejaculatory dysfunction

What are the different surgical sperm retrieval techniques?

  1. TESA (Testicular Sperm Extraction)

This procedure is mainly suitable in patients with obstruction in their spermatic duct also known as obstructive azoospermia (due to infections, trauma), post-vasectomy (where surgical reversal has failed), and sperms in the ejaculate with high DNA Fragmentation Index.

  1. PESA (Percutaneous Epididymal Sperm Aspiration)

This procedure uses a fine needle to aspirate sperms from the “Epididymis” which is a sperm-rich tube at the back of the testis where the sperms get stored before ejaculation.

  • MESA(Microscopic Epididymal Sperm Aspiration)

This procedure uses microsurgical procedure to collect sperm from Epididymis under high magnification in cases of extremely low sperm production.

  1. MicroTESE (Microscopic testicular sperm extraction)

Micro testicular sperm extraction (micro TESE) is a microsurgical technique used to retrieve sperm from the testes. It is a revolutionary treatment that serves to counter severe male factor infertility (azoospermia) caused by low sperm production.


 In typical cases of nonobstructive azoospermia, the testicles harbour small pockets of sperm, characterised by prominent testicular tubules. During micro TESE, these tubules are carefully extracted and transferred to a petri dish containing culture media. An embryologist then examines the specimen for sperm, under a microscope. Once healthy sperm are identified, they are injected into a set of mature eggs for fertilisation.


Micro TESE is an advanced technique that presents better chances of finding healthy sperm than a random biopsy. The probability of finding sperm using micro TESE is more than 60%. Also, since micro TESE is best performed on the same day as an egg retrieval routine, sperm can be injected without being frozen beforehand, in turn, assuring optimal quality.


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