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The usual way of producing sperm for use in Assisted Reproductive Technology is manual stimulation (masturbation).  In cases where there are no enough live sperm cells in the ejaculate, then surgical sperm retrieval becomes an option. If there are no live sperm cells in the ejaculate, the semen analysis will indicate zero sperm count and diagnose you with azoospermia. With such a diagnosis, patients often wonder if azoospermia can be treated or if there is a cure for zero sperm count. There is no easy answer to these questions. However, depending on your unique case, there might be treatment alternatives.

Surgical sperm retrieval is often used in cases where the male patient has undergone vasectomy and there are no live and viable sperm cells in his ejaculate. Also, patients who have been diagnosed with azoospermia will be ideal candidates for surgical sperm extraction. 

Azoospermia is a condition where the male patient has no live or viable sperm cells in his ejaculate. If such diagnosis has been made, surgical sperm extraction methods such as PESA, TESA or MESA will become an option. The choice among these options will depend on your unique assessment by our clinicians. 

Azoospermia can be categorized as obstructive and non-obstructive azoospermia. In obstructive azoospermia, sperm is unable to make it outside to the ejaculate due to some sort of a blockage in the sperm delivery channels. If you have been diagnosed with obstructive azoospermia, chances are, we will be able to obtain a sperm sample through surgical extraction, which will be of sufficient criteria for use during the ICSI procedure.

Non-obstructive azoospermia, on the other hand, refers to problems in sperm production due to genetic disorders or birth defects. The likelihood of obtaining viable sperm for fertilization with non-obstructive azoospermia is less likely.

MESA 
The most invasive of the surgical sperm retrieval procedures is MESA (micro-epididymal sperm aspiration), which is performed under general anesthesia. MESA involves the cutting open of the scrotum to retrieve sperm. The wound is closed with dissolvable stitches. Swelling and pain subsides within a few days, during which prescribed painkillers may be taken to ease the pain.

PESA (percutaneous epididymal sperm aspiration) is a method, performed under local anesthesia, which involves extracting sperm with a fine needle from the epididymis or testes.  The sperm is then implanted into the egg through the process of ICSI (Intracytoplasmic Sperm Injection) to be used in IVF.

TESA & TESE
In cases where the epididymis does not contain any sperm, because of impaired sperm production, the method of TESA (Testicular Sperm Aspiration) or TESE (Testicular Sperm Extraction) may be used.  TESE involves a surgical biopsy of the testis, while TESA is performed by sticking a needle into the testis and aspirating fluid and tissue with negative pressure.


Surgical Sperm Extraction: Management of Obstructive Azoospermia