Testicular sperm extraction typically refers to the removal of sperm directly from a male’s testicles using a needle. This procedure is most often used in the treatment of infertility in men who do not have sperm present in their semen. Various conditions may cause this, including a blockage in the passage leading from the sperm reservoir and the testicles. Sometimes surgical procedures may also be used to remove the sperm.
Sperm are small one-celled organisms produced by the male testicles. When joined with a woman’s ovum, fertilization can occur and a pregnancy is the result. They are manufactured by the testicles and then stored in a small organ located just above the testes called the epididymis. In most cases the sperm are secreted during ejaculation, combined with a thick, milky, fluid called semen that is used to sustain and mobilize the sperm. When no sperm are present in the semen during ejaculation, such as in men who have had a vasectomy, testicular sperm extraction may be used.
In one method of testicular sperm extraction, a microscope is used to view the area and very small surgical instruments are used to remove sperm directly from the reservoir. At other times, a needle is inserted into the epididymis and sperm is extracted in that way. Needle aspiration is the most common method because it is more widely available. Once the sperm are removed they are examined for health and mobility, and the healthy ones are frozen for later use.
Testicular sperm extraction is not typically used for artificial insemination, or the insertion of sperm into the uterus for fertilization. The main reason for this is that there are often not enough sperm present in a single extraction. They are more often used in in vitro fertilization. This is sperm and ova are combined artificially and then inserted into the uterus once an embryo has been formed.
When going in for testicular sperm extraction, the testicles and surrounded area are numbed with a local anesthetic. Many centers do this as an outpatient procedure, meaning the patient can leave again on the same day. If no viable sperm are found with a single extraction, another may be needed.
Other methods for treating male infertility are often used before doing testicular sperm extraction. If a patient has had a vasectomy, a reversal may be attempted. A semen sample may be tested to determine if sperm are present, and if there are, if they are healthy and mobile. If there are sperm present in lower than normal numbers, in vitro fertilization may be attempted without using additional extracted sperm.