Today with the availability of intracytoplasmic sperm injection techniques , it has become possible to achieve fertilization and pregnancies with only a few spermatozoa or even in men who produce no spermatozoa in the ejaculate. But in men with Aspermia (inability to ejaculate) and in men with Azoospermia (absence of sperm in ejaculate ), sperms have to be obtained by some sperm retrieval technique prior to ICSI. Retrieval of sperms may be done by non-surgical or surgical methods.
Absence of sperms in the ejaculate is known as azoospermia and this may be obstructive or non obstructive in etiology
1. Percutaneous Epididymal sperm aspiration (PES A)
2. FNA of testis (TESA)
3. Open testicular biopsy (TESE)
4. Microsurgical Epididymal sperm aspiraton (MESA )
1. All cases of obstructive azoospermia with normal spermatogenesis e.g. Congenital bilateral absence of vas deferens.
2. Failed vasectomy reversal.
3. Ejaculatory dysfunction
4. Spinal cord injury
5. Retrograde ejaculation
1. Obstructive azoospermia (CBA VD)
2. Failed vasectomy reversal
3. Partial testicular atrophy
Non obstructive Azoospermia
Sperm retrieval of husband is done on the same day when wife's eggs are retrieved . Under local anaesthesia or mild sedation, needle is introduced through the scrotal skin and sperms aspirated . Antibiotics and pain killers are given and the patient can go back home after a few hours.