For couples experiencing fertility difficulties, semen analysis tests are among the most common male fertility tests carried out at our London clinic. These tests are able to provide a sperm count, which shows how much sperm is present in a man’s ejaculate.
Sometimes during a semen analysis, no sperm are seen in the ejaculate. This is called azoospermia, a condition where men ejaculate but it doesn’t contain any sperm, which can occur due to several reasons. Sometimes azoospermia is due to an obstruction, such as a previous vasectomy or previous infections. In these cases, the sperm itself may be normal and healthy, but it can’t fertilise the egg because it can’t actually reach it.
In other cases, azoospermia is caused by a production problem within the testicle itself. Lack of sperm in the ejaculate can also be due to hormonal reasons, or maybe a man can’t ejaculate at all – from a spinal cord injury or certain psychological factors.
If a zero sperm count/azoospermia is detected, the andrology specialists at King’s Fertility will be able to arrange any further tests that may be required, and discuss any treatment and next-step options with you. Finding out your sperm count is extremely low or zero can feel very alarming but in many cases there are things we can do to help, including surgical sperm retrieval (SSR).
A number of different surgical sperm retrieval procedures are available, depending on the underlying cause of your azoospermia. Generally, the aim of SSR is to surgically extract sperm so that it can be used for fertility treatment.
These are the different types of surgical sperm retrieval procedures available at our London andrology clinic:
1.Percutaneous epididymal sperm aspiration (PESA)
The simplest procedure where sperm is aspirated through the skin using a fine needle and syringe from the epididymis (a structure above the testicle where sperm is stored and matures).
2.Micro-epididymal sperm aspiration (MESA) –
A procedure which involves a small cut to the scrotum to allows direct microscopic visualisation of the epididymis using a microscope so that sperm can be aspirated.
3.TESE (Testicular sperm extraction)
A small biopsy is taken from the testicle and sperm is retrieved directly from the tissue.
This is the most advanced procedure. A cut to the scrotum allows access to the testicles. These are then opened and multiple small biopsies are taken under microscopic visualization, targeting areas of the testes more likely to contain sperm using a microscope.
All procedures will require you to have anaesthetic – which is either local for PESA and TESE, or sedation for the other two – but while this may sound alarming, you will still be in and out the same day. Once it is all done, and we have the sperm, we can freeze it and be ready to continue the rest of the IVF cycle: stimulating the ovaries, collecting the eggs, injecting the most appropriate sperm into the appropriate egg, and transferring the fertilised embryo into the womb.