Information for surgical sperm retrieval patients

Surgical sperm retrieval (SSR) at cambridge IVF

In some cases of azoospermia (where a man produces no sperm in the ejaculate) it is possible for us to perform one of a number of surgical procedures to collect sperm which can then be used for ICSI treatment. Your consultant will have made a diagnosis based on your own individual circumstances and will recommend the treatment which is most likely to result in the successful retrieval of useable sperm from the options outlined below.

What will happen on the day of my procedure?

Some surgical procedures requiring a general anaesthetic will be performed at the main Addenbrooke’s Hospital site whereas those which require local anaesthetic only will be performed at Cambridge IVF. Irrespective of the location of your procedure, rest assured you will receive the same exceptional standard of care.

On the morning of the procedure, please have a bath or shower. If your procedure is under local anaesthetic you may have a light breakfast before 9am, for general anaesthetic procedures please follow the pre-operative plan that you have been provided with. Although we have patient lockers available we always recommend you do not bring any valuables with you. Bring any medication or inhalers that you are taking with you. You may wish to bring a CD with you if you would feel more comfortable with some soft music of your choice playing during your procedure.

A doctor will see you before the procedure to take your consent for the procedure and answer any questions you might have. A member of the laboratory team will then perform the necessary witnessing procedures with you and ask you to sign the pre-operative witnessing form. You are welcome to ask any questions you may have at this time. The procedure can take up to one hour so you can expect to be with us for approximately 2 hours in total for a local anaesthetic procedure but longer where the procedure requires a general anaesthetic.

You will be asked to remove your clothes and will be provided with a theatre gown. A nurse will escort you to the theatre suite where the minor operation to retrieve your sperm will be performed. Before leaving you will be informed about the success of your sperm retrieval. It may be possible to freeze sperm following the procedure. You will need to give your written consent to freeze and store sperm and you will be tested for HIV, Hepatitis B, and C. We will discuss this in more detail on the day of the procedure.

After the operation you will be offered a drink and given time to recover. You will be free to go home soon afterwards. You should organise for someone to take you home by car or taxi.

Before you leave you will be given written discharge advice and information.

What are the different procedures available?

Electro-ejaculation

Although not by definition a surgical procedure, Electro-ejaculation can be very successfully used to obtain semen samples from men suffering from ejaculatory dysfunction, most commonly caused by damage or disease of the nervous system. The process is routinely carried out under general anaesthetic. A specifically designed electric probe is inserted into the rectum and located adjacent to the prostate. The probe then delivers a slight electric current that stimulates the nearby nerves resulting in contraction of the pelvic muscles stimulating the ejaculatory reflex and producing a semen sample which can be collected for use in fertility treatment.

Percutaneous epididymal sperm aspiration (PESA)

PESA is the most common and least invasive surgical procedure, which very successfully yields sperm in cases of obstructive azoospermia (where the tubes supplying sperm from the testicles have become blocked or are even absent). Usually under a local anaesthetic a very small and fine needle linked to a small syringe is used to aspirate sperm directly from the epididymis. A small amount of suction is applied to the tube and minute drops of fluid can be aspirated. The aspirated fluid is examined under a microscope by a member of the laboratory team who will inform the doctor when enough sperm have been collected. If no sperm is found after several attempts we may proceed to take a Testicular Biopsy.

Testicular sperm extraction (TESE)

A Testicular Biopsy can be an option for sperm retrieval if a PESA has been unsuccessful. Alternatively the doctor may advise this procedure as the most likely to retrieve sperm in the first instance, and this minor operation can be performed under a local or general anaesthetic depending upon your personal circumstances. A small incision is made into the testicle and a sample of tissue is taken to be processed in the laboratory. This involves gently grinding the testicular tubules to allow any sperm within the tubules to be carefully collected. These sperm can then be used in you fertility treatment. This is a minor operation which can be used diagnostically to assess sperm production and in such cases a small tissue sample is sent to the histology laboratory where the tissue is examined for evidence of sperm production.

What are the risks of the procedure?

The main risks are bleeding, infection and pain after the procedure. These are highly unusual and you will be given discharge advice following the procedure. There will always be some degree of bruising and swelling which should settle over a week or two. A support and padding is provided to reduce these risks.

Can I freeze any sperm collected for use in future treatment?

If a sufficient number of sperm are aspirated we are able to offer you freezing. These samples could be used for your fertility treatment to help you to have a child in the future without undergoing any further surgical procedures. The storage of sperm is an activity regulated by the Human Fertilisation and Embryology Authority, (HFEA). You will need to sign some consent forms, and a blood test will have to be taken to screen for HIV, Hepatitis B and Hepatitis C. We do not have facilities to store ‘high risk’ samples so if you test positive for any of these conditions we will not be able to store your sperm. More detailed information is available in our booklet ‘Sperm Storage – Information for Patients’

If I can’t have an SSR or no sperm are recovered, what are our options?

If you feel that you wish to consider using donor sperm in your fertility treatment, a donor counselling session can be arranged prior to commencing treatment to explore all the issues around using donor sperm. We have information available to you on the use of donor sperm and issues surrounding legal parenthood when donor sperm is used. Please feel free to discuss this with us.

What are the success rates and how much does it cost?

Cambridge IVF is a brand new and state of the art facility so we are not able to offer you previous year’s data of success rates. What we can do is assure you of our pedigree; our team has been carefully put together with a wealth of experience in the profession spanning more than 10 well respected clinics across the UK and Europe.

The cost for treatment, if you are not eligible for NHS funded treatment, are given on a separate sheet. Please ask for one if you have not already received it.

We hope you have found this booklet informative and interesting. We realize we may not have covered all of your questions so if you do have any other queries we are here to help so please contact us via any of the means below;

Cambridge IVF
Kefford House
Maris Lane
Trumpington
Cambridge
CB2 9LG

Switchboard: 01223 349010

Email Cambridge IVF

Cambridge IVF website (opens in a new tab)