In rare cases of male infertility, men will not have sperm present in the ejaculate, a condition called azoospermia. Many of these men will have an obstruction or blockage somewhere along the male reproductive tract. The most common cause of obstructive azoospermia (OA) is a vasectomy, but other causes include infection, trauma, surgery and a genetic disease called cystic fibrosis. In other men, the cause of azoospermia is not a blockage, but very poor sperm production. These men have what is called non-obstructive azoospermia (NOA).

Regardless of the cause, almost all men with azoospermia are candidates for collection of sperm from the testicles or surrounding reproductive tract using various surgical techniques. Surgical sperm retrieval at the Ottawa Fertility Centre is performed by one of our affiliated Urologists. The collected sperm can then be used in in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI).

Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Extraction (TESE) PESA involves retrieval of sperm from a structure called the epididymis and is performed under local anaestheic or freezing. A small needle is placed into the epididymis and sperm is aspirated. Occasionally PESA is not successful in recovering sperm. In these cases, TESE can be performed to retrieve sperm directly from the testicle. Under local anesthetic, a small incision is made in the scrotal skin and testicle and a small amount of testicular tissue containing sperm is removed. Both PESA and TESE are performed on men with obstructive azoospermia. The recovered sperm can be frozen for later use.

Microsurgical Testicular Sperm Extraction (microTESE) MicroTESE is an effective technique for retrieval of sperm from men with non-obstructive azoospermia (NOA). MicroTESE is performed in the operating room under general anaesthetic. Using an operating microscope, small areas of testicular tissue that are likely to contain sperm can be identified and removed. Recovered sperm are used immediately for ICSI; however, any excess sperm can be cryopreserved for later use. There is a 50% chance of finding sperm with this technique.

For a more detailed description of surgical sperm retrieval, please click on the appropriate patient information sheet :