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Surgical sperm extraction

If you have no, or extremely low numbers of, sperm in your semen which means you can’t have a standard fertility treatment, you may be able to have sperm collected surgically. This page will introduce you to your options and chances of success.

What is surgical sperm extraction?

Men who have no sperm in their semen and who want to have children may be able to have treatment to collect the sperm surgically. There are five different kinds of treatment:

  • Percutaneous epididymal sperm aspiration (PESA)
  • Microsurgical epididymal sperm aspiration (MESA)
  • Testicular sperm aspiration (TESA)
  • Testicular sperm extraction (TESE) - single or multi-site
  • Microscope-assisted testicular sperm extraction (MicroTESE)

Who might have surgical sperm extraction?

You may have PESA, MESA, TESA or TESE if you have no sperm in your semen due to a blockage (obstructive azoospermia). This could be because:

  • you’ve had a vasectomy
  • you’ve had a sexually transmitted infection like chlamydia

You may also have these treatments if you are unable to ejaculate (retrograde ejaculation or anejaculation).

You may have MicroTESE if you have no sperm in your semem due to a sperm production problem (non-obstructive azoospermia). This could be because:

  • you’ve had chemotherapy or radiotherapy and your fertility hasn’t returned to normal
  • you have a genetic condition that affects your fertility
  • you’ve had a testicle removed (perhaps as part of cancer treatment)
  • you’ve had surgery to bring down undescended testes

Is there anyone these treatments aren’t right for?

Unfortunately these treatments wouldn’t work for men with certain genetic conditions. Your clinic will explain if this applies to you.

Why do some men have no sperm in their semen?

Often it’s due to genetics but it can also occur as a result of a sexually transmitted infection or certain medical treatments. In some cases no cause can be found in the same way that some female fertility problems have no known cause.

What do the treatments involve?

PESA and TESA

PESA and TESA involve a fine syringe being inserted into either the epididymis or the testicle to extract the sperm. It’s a quick and relatively painless procedure that’s usually performed under local anaesthetic.

TESE

TESE involves making an incision into the testicle to take a small sample (biopsy) away from which sperm can hopefully be recovered.  TESE can be performed under local or general anaesthetic. Multi-site TESE (where multiple samples are taken from different areas) is usually performed under general anaesthetic.

MESA and MicroTESE

MESA and MicroTESE are both performed under general anaesthetic. MESA involves examining the epididymis under an operating microscope and taking fluid samples for further examination to see if there are any sperm.

MicroTESE involves examining the testicle with an operating microscope to find areas (tubules) where sperm are being made. The promising areas are taken out and sperm extracted if possible. Many experts believe that MicroTESE has the best chance of recovering sperm from men with non-obstructive azoospermia. You’ll probably be given painkillers and asked to rest for a couple of days after the procedure.   

If the sperm removed is of poor quality your clinic may recommend you use them straight away rather than freeze them as poor quality sperm is less likely to survive the freezing process.

Download a leaflet on surgical sperm retrieval from the British Fertility Society

Are there any side effects?

Side effects tend to be rare but bleeding and infection can occur. A small number of men experience a drop in their testosterone following surgical sperm retrieval, which may cause problems with sexual function, sleep, muscle weakness and anxiety. If you have any side effects at all you should contact your clinic straight away.

Men who have fertility problems are also slightly more likely to develop testicular cancer so it’s very important you check your testicles regularly for lumps.

What should I expect when I first go to the clinic?

Initially you’ll probably just be asked to answer a few questions and your genitals may be examined. If necessary you may then be asked at a later date to have some blood tests or produce a sperm sample (if you’re able).

How successful is surgical sperm extraction?

If you’re having a MicroTESE for non-obstructive azoospermia there’s a 50% chance of sperm being successfully extracted. Your chances are higher if you’re having a procedure for obstructive azoospermia.

However it’s important to be aware that even if sperm is successfully extracted there’s no guarantee you’ll be able to have a child. Your sperm will need to be used in a fertility treatment like intracytoplasmic sperm injection so your chances of having a baby will depend on how successful the treatment is and whether your sperm are of high quality.

Are there any risks from using sperm collected in this way?

There is no evidence that sperm collected surgically affects your chances of getting pregnant or that it poses a risk to the health and wellbeing of any children you might conceive.  Research has shown that sperm extracted surgically may not fertilise as well, although this could be due to the fact that some sperm is of lower quality.

What can I do if it doesn’t work?

If you’ve had surgical sperm extraction and it hasn’t been successful you may want to consider other options for having a family, such as using donor sperm in treatment or adopting. 

Find out more about using donated sperm in treatment

Find out more about coping if treatment doesn't work

You may also want to think about accessing specialist infertility counselling. Even if you have a partner, family and friends who can support you, sometimes it can help to talk your options through with an informed and trained professional.

Find an accredited infertility counsellor

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What are the next steps for having surgical sperm extraction?

You can search for licensed UK clinics that offer surgical sperm extraction on our website.

Choose a fertility clinic

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Review date: 5 July 2019

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