What is sperm retrieval surgery and who may need it?
In this guide, Mr Jas Kalsi, one of the leading male fertility experts in the UK and Consultant Urologist at Cromwell Hospital, explains what sperm retrieval surgery involves, who may benefit from it, and what to expect during treatment.
If you are a man or a partner of a man who has been told that no sperm has been found in your semen sample (Azoospermia), it can be difficult to know where to go for specialist help and support.
This situation is often found when a couple have had trouble trying to conceive naturally, when they are exploring fertility treatment options, after a previous vasectomy or after cancer treatment.
When no sperm is found in the ejaculate, sperm retrieval surgery may be helpful to find and store sperm. While it can sound daunting, these procedures have helped thousands of men become biological fathers, often in situations where natural conception is not possible.
In this guide, Mr Jas Kalsi, who is one the leading male fertility experts in the UK and Consultant Urologist at Cromwell Hospital, explains what sperm retrieval surgery involves, who may benefit from it, and what to expect during treatment.
What is sperm retrieval surgery?
Sperm retrieval surgery is a group of procedures used to collect sperm directly from the testicles or the epididymis (the tube that stores and transports sperm) when sperm cannot be obtained through ejaculation.
The sperm collected can then be used fresh or frozen and used as part of assisted fertility treatments, most commonly intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into an egg in a laboratory.
Sperm retrieval may be recommended when a man's fertility is affected by a blockage, a previous surgical procedure, or problems with sperm production.
Obstructive azoospermia
This occurs when sperm are being produced normally but cannot reach the ejaculate due to a blockage in the reproductive tract.
Common causes include:
- Vasectomy
- Congenital absence of the vas deferens
- Previous infections
- Previous surgery affecting the reproductive tract
- Injury or scarring
Non-obstructive azoospermia
This occurs when the testicles produce very low numbers of sperm or none at all.
Potential causes include:
- Genetic conditions such as Kleinfelters syndrome or deletions of the AZFc part of the Y chromosome
- Hormonal disorders such as hypogonadism
- Previous chemotherapy or radiotherapy
- Undescended testicles
- Testicular injury
- Unexplained causes
Even when no sperm are found in the semen, they may still be present within the testicular tissue and suitable for fertility treatment.
Who may need sperm retrieval surgery?
Sperm retrieval surgery may be recommended for men who:
- Have obstructive azoospermia
- Have non-obstructive azoospermia
- Have previously had a vasectomy and are pursuing fertility treatment
- Are unable to ejaculate due to neurological conditions or spinal cord injury
- Have had unsuccessful attempts to obtain sperm through other methods
- Are preserving fertility before cancer treatment
- Require sperm collection for IVF or ICSI treatment
Following a full fertility assessment, a specialist can determine whether sperm retrieval is likely to be successful and which technique may be most appropriate.
PESA (Percutaneous Epididymal Sperm Aspiration)
PESA involves using a fine needle to retrieve sperm from the epididymis.
It is commonly used in men with obstructive azoospermia, including those who have had a vasectomy.
Benefits include:
- Minimally invasive
- Performed under local anaesthetic or sedation
- Quick recovery
- No surgical incision
Micro-TESE
The gold standard Microdissection TESE, often called Micro-TESE, is a more advanced technique used particularly in men with non-obstructive azoospermia.
Using an operating microscope, the surgeon carefully identifies areas of the testicle most likely to contain sperm, helping maximise the chances of successful retrieval while preserving healthy tissue.
For many men with severe sperm production problems, Micro-TESE may offer the best opportunity to find usable sperm.
Is sperm retrieval surgery successful?
Success rates depend largely on the underlying cause of infertility.
Men with obstructive azoospermia typically have a high likelihood (>90%) of successful sperm retrieval because sperm production is usually normal.
For men with non-obstructive azoospermia, success rates vary (30-60%) depending on the cause and the presence of sperm-producing tissue within the testicles.
A specialist fertility work-up, including hormone testing, genetic investigations and imaging where appropriate, can help assess the likelihood of success before treatment.
What is recovery like after sperm retrieval?
Recovery is generally straightforward.
Most men experience:
- Mild discomfort or bruising
- Temporary swelling
- A short recovery period of a few days
Patients are usually advised to:
- Avoid strenuous exercise for a short period
- Wear supportive underwear
- Follow post-operative care instructions carefully
Your consultant will explain any specific restrictions based on the procedure performed.
Can sperm retrieval help after a vasectomy?
Yes. Men who have previously undergone a vasectomy may still be able to father biological children through sperm retrieval and assisted fertility treatment.
In some cases, vasectomy reversal may be an option. In others, sperm retrieval combined with IVF and ICSI may offer the most effective route to pregnancy.
A consultation with a male fertility specialist can help determine which approach is most suitable.
Fertility preservation before cancer treatment
Cancer treatments such as chemotherapy, radiotherapy and some surgeries can affect fertility.
Whenever possible, fertility preservation should be discussed before treatment begins.
For men who are unable to produce a semen sample or where sperm collection is challenging, sperm retrieval surgery may provide an opportunity to preserve fertility for the future.
Sperm retrieval at Cromwell Hospital
Mr Kalsi is one of the UK’s leading male fertility and microsurgery experts and has set up this service for patients both from the UK, Europe and beyond at Cromwell Hospital based in Kensington in Central London.
We offer a streamlined, professional service including a full work up, analysis of previous results and microsurgery to find the very best sperm that can then be frozen and used in association with the UK’s leading IVF units.
About the author
Mr Jas Kalsi is an experienced world leading Consultant Urological Surgeon and Andrologist. He is a men’s health expert and can fully evaluate the hormonal, structural and genetic problems that may be impacting a man’s ability to successfully conceive. He has a passion for treating patients using minimally invasive techniques such as microsurgery so that they may return to normal activities quickly with the highest success rates. He specialises in treating men with very low and no sperm in the ejaculate including treatment of high DNA fragmentation and varicoceles.
