Non-surgical Sperm Retrieval
If you have anejaculation or retrograde ejaculation, ejaculation can be induced. Then the semen is collected.
Two methods are:
Penile Vibratory Stimulation (PVS)
PVS is done with a special vibrator placed at the tip of the penis. This stimulation can cause an ejaculation.
EEJ is done with a probe that sends electrical energy to the prostate and seminal vesicle. EEJ may be done in the urologist's office for men with nerve injuries and no feeling. But for men who have normal sensation, general anesthesia is needed. General anesthesia is used to prevent pain during this EEJ procedure. It makes you unconscious. You do not feel any pain, and you do not remember the procedure afterwards.
If PVS or EEJ don't work, a sperm retrieval method from the epididymis or testicle may be needed.
Testis Sperm Retrieval
There are many ways to get sperm from the reproductive tract. The goal is to get the best quality and number of sperm. Care is taken not to harm the reproductive tract. This will allow future sperm retrieval or reconstruction, if needed.
Some of these procedures are:
Testicular Sperm Extraction (TESE)
TESE is often used to diagnose the cause of azoospermia. It can also get enough tissue for sperm extraction. The sperm can be used fresh or frozen (“cryopreserved”). TESE is often done in the urologist's office with a nerve block. A nerve block is an anesthetic injected into nerves to treat pain. The nerve block will "turn off" a pain signal from a specific location; in this case, from the testis. Or, TESE can be done under anesthesia in a surgical center. It involves one or several small cuts in the testes.
Testicular Sperm Aspiration (TESA)
TESA is also sometimes called Testicular Fine Needle Aspiration (TFNA). TESA can be used to diagnose or treat azoospermia. It can also be used to collect sperm from the testicles. It's often done with a nerve block in the Urologist's office or the operating room. A thin needle punctures the skin and testis to gently pull out sperm. No other cuts are needed.
TESA with Mapping
This is where TESA is done with many needle aspirations spread throughout the testes. Aspiration is a medical procedure used to remove tissue samples. Some physicians feel this method is comparable to TESE at recovering sperm. TESA is sometimes used for patients with non-obstructive azoospermia.
Microsurgical Epididymal Sperm Aspiration (MESA)
MESA uses a surgical microscope to help retrieve sperm from the epididymis tubes. MESA can retrieve lots of healthy sperm that can be saved and frozen for later. This method is very safe. However, it calls for general anesthesia and a highly skilled micro-surgeon.
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA, like TESA, can be done many times at low cost and without a surgical cut and is especially suited for obstructive azoospermia. It doesn't need a high-powered microscope, so more urologists can do it. PESA is done under local or general anesthesia. The urologist sticks a needle attached to a syringe into the epididymis to gently remove fluid. Sperm may not always come out this way. Sometimes a surgical process is needed.
Microsurgical Testicular Sperm Extraction (Micro-TESE)
Micro-TESE is done only for non-obstructive azoospermia. The outer cover of the testicle is opened and the inside is checked. Your urologist can see areas more likely to be making sperm. This technique is done by a Urologist trained in microsurgery. Micro-TESE is usually done in the operating room. This way, more of the testis is examined, but less tissue is removed. There's also less damage to the blood vessels. Some feel Micro-TESE offers a better chance of finding sperm in the patient with non-obstructive azoospermia.