Other Fertility Treatments at Trinidad IVF Centre

About one man in a hundred produces no sperm in his semen - a condition known as azoospermia. For some of these men it may be possible to surgically retrieve sufficient sperm directly from the testes. These sperm can then be used with IVF and ICSI procedures to create a pregnancy. Surgical sperm retrieval is also used in men who cannot ejaculate, for example after a spinal cord injury.

Azoospermia (no sperm in the ejaculate) can occur for many reasons and may be due to:

• A previous illness (eg mumps in adolescence)
• trauma or injury to his groin
• a genetic condition
• ejaculation going backwards into the bladder (retrograde ejaculation), which can happen after prostate procedures and for other reasons
• cancer treatments
• vasectomy (the male sterilisation operation)

This procedure is offered to men where sperm production is present in the testes. A blood test to look at both male hormones and genetics can help predict which men might be producing sperm and which men probably are not. An ultrasound of the testes and scrotal area may also be performed. These tests help the doctor predict what percentage chance a man has that a surgical sperm retrieval procedure will find sperm that can be used to create a pregnancy.

The procedure is a simple, low-risk, day case procedure. It is performed by a specialized surgeon in our private fertility theatre, in the IVF clinic at Medical Associates Hospital.

The procedure is usually planned in advance but in exceptional circumstances can also be carried out as an emergency procedure if the man is unable to produce a sperm sample when needed during fertility treatment. 

For the procedure, sedative drugs are given to enable you to sleep and feel no pain. Sometimes a general anaesthetic may be required. You will be in the fertility unit for between 2-6 hours.

There are three different methods to surgically retrieve sperm:

• PESA is the least invasive method and involves inserting a fine needle into the epididymis – this is the sac lying in the scrotum just above the testes where sperm are stored before ejaculation. PESA is particularly suitable for men who have had a vasectomy, or who were born without a vas deferens (the tube that transports sperm from the testes to the penis)
• TESA involves passing the needle directly into the testis to remove a microscopic core of tissue
• TESE involves making a small cut in the skin of the scrotum to directly remove (biopsy) several small sections of testicular tissue

As the surgeon gets samples of tissue, these samples are passed immediately to the IVF laboratory where a scientist checks under a microscope to see if sperm have been found and if the sperm are suitable for treatment.  Once enough sperm are identified, the procedure is finished. 

If sperm are found, using the surgical sperm retrieval procedure, they are usually frozen and stored for your future use. To understand more about sperm freezing, please ask clinic staff for the patient information sheet on Sperm Freezing (LC127).

• Surgical sperm retrieval procedure with all hospital, drugs and doctor fees
• Recovery room and nurse monitoring before and after procedure
• IVF laboratory fees
• Sperm freezing and storage of frozen sperm for 3 months

• The first doctor’s appointment to discuss your treatment options
• Follow-up consultation with the doctor
• IVF and ICSI treatment that use the sperm to create a pregnancy
• Storage fees for longer than three months. Storage fees need to be paid in advance for every year of storage. Please ask the clinic staff how this applies to you