Semen can be recovered from two main areas:
- from the epididymis, that is, the structure next to the testicle where the spermatozoa are stored and matured before ejaculation,
- by the testicle, that is, from the tissue where the production of spermatozoa takes place.
The choice of the area depends mainly on whether azoospermia is obstructive or non-obstructive.
Sperm recovery techniques from the epididymis
Pesa — Percutaneous aspiration of sperm from the epididymis
the Pesa It is one of the simplest sperm recovery techniques. It is usually performed under local anesthesia and involves the collection of fluid from the epididymis with the help of a fine needle and syringe.
This technique is mainly applied in cases of obstructive azoospermia, where the production of spermatozoa in the testicles is maintained, but there is an obstacle in their transport to ejaculation.
PESA is less invasive, short and can be an appropriate choice in selected cases. However, it is not always possible or successful, and in some cases a different technique may be needed.
MESA — Microsurgical retrieval of sperm from the epididymis
the mesa It is a more specialized microsurgical technique, in which the epididymis is immediately visualized using a microscope, in order to collect sperm more accurately.
This method requires a surgical environment and is usually performed under general anesthesia. It can be applied when the transdermal collateral is not feasible, when a previous PESA attempt has failed, or when a more targeted approach is needed.
In some cases, the microsurgical approach can also help to evaluate or even correct an obstructive problem, depending on the findings and the case.
Sperm recovery techniques from the testicle
Micro-TESE — Microsurgical extraction of sperm from the testicle
the Micro-Tese It is a specialized sperm recovery technique from the testicle. It is mainly applied in cases of non-obstructive azoospermia, where sperm production is very limited or is found only in small areas of the testicular tissue.
The procedure is performed under general anesthesia. With the help of a surgical microscope, the urologist examines the testicular tissue and takes small samples from areas that are more likely to contain sperm.
The samples are then examined in the laboratory, with the aim of finding even a small number of sperm that could be used for microinsemination.
Micro-TESE is more intrusive than other techniques, but is an important choice in difficult cases of non-obstructive azoospermia, where sperm recovery is demanding and requires specialized experience.
When is sperm recovery planned?
Sperm recovery can be programmed in two main ways.
In several cases, the procedure is done in advance and, if sperm are found, they can be frozen for future use in an IVF cycle.
In other cases, recovery can be synchronized with the stimulation of the woman's ovaries and the day of ovulation. This means that the surgical team and the urologist are ready on the same day the eggs are collected.
The choice between fresh and frozen sperm depends on the type of azoospermia, the amount and quality of the sperm that may be recovered, and the overall therapeutic design.
Although frozen sperm can be effective, in some cases non-obstructive azoospermia the amount of sperm recovered is extremely small. This means that there is a chance that some sperm will not survive after the freezing and thawing process. For this reason, the planning must be done with special care, so that the eggs are available, either by ovulation on the same day, or they are frozen and thawed if sperm is found, on the day of sperm recovery.
