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While facing a diagnosis like azoospermia can feel overwhelming, understand you are not alone in this experience. As your fertility doctor, my goal is help you understand all available treatment options, both natural remedies as well as surgical interventions, so you can make the choice that feels best for your individual situation.

Azoospermia means an absence of sperm in the ejaculate, which can impact fertility. However, new findings from research are expanding our knowledge of both the causes and potential treatments.

In this post, I aim to provide you with a detailed understanding of different surgical options that have helped other men struggling with azoospermia regain their fertility & fulfil dream of a complete family.

I hope that you leave feeling empowered with information to have an informed discussion with me or a fertility specialist about crafting a personalized care plan. Let’s get started!


Microscopic Epididymal Sperm Aspiration (MESA)


Microscopic Epididymal Sperm Aspiration (MESA) is a surgical procedure aimed at extracting sperm directly from the epididymis, a tightly coiled tube located behind each testicle where the sperm matures.

MESA is generally performed when there is a blockage preventing sperm from being ejaculated, usually caused by vasectomy, congenital absence of the vas deferens, or infection.

It’s an outpatient procedure performed under general or local anaesthesia, making the patient comfortable throughout the procedure.

The procedure involves making a small incision in the scrotum to expose the epididymis. The surgeon then uses a microscopic needle to puncture the epididymis and extract the sperm.

The extracted sperm can be used immediately for In Vitro Fertilisation (IVF) or frozen for future use.

The benefits of MESA include a high success rate in retrieving sperm and the ability to obtain a large number of sperm, which may allow for multiple IVF cycles.

Moreover, as it’s done under a microscope, it minimises damage to the surrounding tissues, reducing post-operative complications and discomfort.

However, potential risks of MESA include infection, haematoma (swelling of clotted blood within the tissues), and risks associated with anaesthesia.

Furthermore, there is no guarantee of successful sperm retrieval in every case, especially in men with very low sperm production.

Always discuss with your fertility specialist to understand if MESA is appropriate for your situation and the potential success rates given your specific fertility concerns.

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA, like MESA, is a technique used for sperm retrieval, particularly in cases of obstructive azoospermia. The key difference between PESA and MESA is that PESA is less invasive; it does not require a surgical incision.

Instead, a small needle is passed directly into the head of the epididymis through the skin and a sample of fluid is withdrawn. This fluid is then examined for the presence of sperm which can be used for IVF.

In terms of candidacy, both MESA and PESA are generally considered for men who have obstructive azoospermia. However, because PESA is less invasive and does not require a surgical cut, it might be the first choice for patients who prefer a procedure with minimal discomfort and shorter recovery time.

It’s also an ideal option when sperm are needed on short notice, as it can be performed without prior planning.

Just like MESA, there’s no guarantee of successful sperm retrieval with PESA, and in some cases, if PESA fails, MESA might be recommended as the next step.

As always, the choice between MESA and PESA should be made in consultation with a fertility specialist, based on a thorough assessment of the patient’s medical history and current health condition.

Testicular Sperm Extraction (TESE)

TESE is another sperm retrieval technique employed primarily for men with non-obstructive azoospermia. It involves a minor surgical procedure where a small amount of tissue is taken directly from the testis and examined for the presence of sperm.

The steps of the TESE procedure are as follows:

  1. The procedure is usually performed under local or general anaesthesia to ensure the patient’s comfort.
  2. A small incision is made in the scrotum to expose the testis.
  3. A small amount of testicular tissue is extracted using a biopsy needle.
  4. This tissue is then analysed in a laboratory for the presence of sperm.

The success rate of TESE varies significantly, primarily depending on the cause of infertility. For men with non-obstructive azoospermia, the success rate can range anywhere from 30% to 70%.

As with MESA and PESA, it’s important to have a detailed discussion with your fertility specialist to understand the potential outcomes and risks associated with TESE.

Sperm Retrieval and Intracytoplasmic Sperm Injection (ICSI)

After the sperm has been successfully retrieved through any of the aforementioned techniques (MESA, PESA, or TESE), it is then prepared for use in Intracytoplasmic Sperm Injection (ICSI), a specialized  form of in vitro fertilization (IVF).

ICSI involves the following steps:

  1. The retrieved sperm are first examined under a microscope to identify the most viable ones for the procedure.
  2. Meanwhile, eggs are retrieved from the female partner through a separate procedure.
  3. Using a fine glass needle, a single healthy sperm is selected and directly injected into the cytoplasm of an egg. This helps to overcome any barriers that might exist preventing the sperm from penetrating the egg.
  4. Once the sperm is inside the egg, fertilisation can take place. The fertilised egg (now an embryo) is allowed to develop in a laboratory for a few days.
  5. The best quality embryos are then transferred back into the woman’s uterus, with the hope they will implant and develop as in a normal pregnancy.

The use of ICSI with sperm retrieved through MESA, PESA, or TESE has significantly increased the chances of conception for couples where male factor infertility is an issue.

It’s important that the couple discuss this and other treatment options in detail with their fertility specialist.

Post-Procedure Care and Potential Complications

After sperm retrieval and ICSI, appropriate care is essential to ensure a smooth recovery and minimise risks. The male patient may experience mild discomfort or pain in the groin area, which can usually be managed with over-the-counter pain relievers.

It’s important to rest and refrain from strenuous physical activities for a couple of days post-procedure to aid healing.

As with any invasive procedure, there is a small risk of infection. Signs of infection could include swelling, redness, persistent pain, or a fever. If these symptoms occur, seek medical attention immediately.

In rare cases, chronic pain can develop. If pain persists beyond a few weeks, it’s crucial to consult with the treating specialist to evaluate the cause and discuss appropriate treatment options.

Although these complications are relatively rare, understanding them can help patients make informed decisions and seek timely medical help if needed.

When to Consult a Fertility Specialist?

If you’ve been trying to conceive for a year or more without success, or six months if you’re above the age of 35, it may be beneficial to consult a fertility specialist.

Other indicators include a history of testicular trauma, prior vasectomy, or issues with sexual function such as erectile dysfunction or premature ejaculation.

Men diagnosed with conditions like azoospermia (no sperm in semen), oligospermia (low sperm count), or abnormal sperm morphology should also seek advice from a reproductive urologist. The presence of these conditions may make you a suitable candidate for sperm retrieval therapies.

It’s vital to consult with a specialist if you have any concerns about your fertility. They can provide a comprehensive evaluation, discuss potential treatment options, and help you make informed decisions about your reproductive health.

Read more:Natural Ways to Improve Sperm Quality

Alternatives like sperm donation or adoption

If sperm retrieval is unsuccessful, there are still other viable options available for building a family. One common alternative is sperm donation. Numerous sperm banks offer a selection of sperm donors, allowing couples to choose a donor whose physical characteristics, educational background, or other attributes align with their preferences.

It’s a regulated process, with all donors undergoing thorough health screenings to ensure the quality of the donated sperm.

Another potential option is adoption. Adopting a child can fulfill the desire for parenthood and offer a loving home to a child in need. It’s a significant decision that involves legal procedures and careful consideration, but it can be a fulfilling option for many couples.

In cases where female fertility isn’t an issue, egg fertilization with donor sperm via In Vitro Fertilisation (IVF) can also be considered. This method involves the fertilization of the egg and sperm outside the body in a laboratory, followed by the transfer of the embryo to the woman’s uterus.

These are just a few examples of the many paths to parenthood. It’s important to discuss these options with your partner and a healthcare professional to determine the best course of action for your personal circumstances.

In conclusion,  infertility can be a challenging and emotional journey, but it’s not an obstacle that you have to face alone. With proper medical care and support, there is still hope for building a family. Explore all the options available to you, and don’t hesitate to seek guidance from professionals who can provide valuable insight and assistance along the way.

Remember, your reproductive health is important, and there is no shame in seeking help to achieve your dream of becoming a parent. So don’t lose hope, keep an open mind, and trust that with determination and perseverance, you can overcome infertility and start the family you’ve always wanted.

  • About Author

    Dr. Supriya Puranik

    Gynaecologist & IVF Specialist

Often known as the last glimmer of hope for people who have lost all hope for conceiving a child, Dr. Supriya Puranik is a leading gynaecologist, high risk obstetrician and Head of IVF & Gynaecology department at Ankura Hospital for Women & Children.

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