What is sperm and how is it produced?

Sperm refers to the male reproductive cell or gamete that plays a vital role in reproduction. Unlike females, who have limited reserves of gametes, males are free from such limitations as the male reproductive system is designed to produce millions of sperm cells (germ cells) every single day. These cells, which are produced inside the testicles, mature over a period of 2.5 months while travelling from the seminiferous tubules through the epididymis into the vas deferens. Once the sperm has been released, its life depends upon the surrounding environment. Healthy male sperm can survive inside the female body for as long as 5 days which is enough to get a woman pregnant under suitable conditions.

Who needs sperm retrieval?

Sperm retrieval is an alternative when a couple intends to conceive a child but requires a little assistance to do so. It can be opted in case of low sperm count and motility, ejaculation problems and Azoospermia which is a condition marked by no sperms in the semen. Azoospermia is further divided into the following two types:

Obstructive Azoospermia - It is a condition in which the testicles produce sperms but their movement is curtailed by a severe blockage in the reproductive tract which prevents them from getting into the semen. This blockage may be a result of any of:

• Severe infection in the testicles, prostate or reproductive tract
• Venereal diseases like Chlamydia
• Defective development or congenital absence of vas deferens
• Damage sustained in an injury or as a result of hernia repair surgery
• Cystic fibrosis triggered by abnormal genes

What are the various methods available for sperm retrieval?

Non-surgical Sperm Retrieval

The procedure is an alternative for males suffering from anejaculation or retrograde ejaculation. The semen is collected by inducing ejaculation artificially, which can be done in two ways:

1. Penile Vibratory Stimulation (PVS) - It involves the use of a special vibrator to stimulate the tip of the penis so as to facilitate ejaculation.

2. Electro ejaculation (EEJ) - It involves the use of a special probe to transmit electrical signals to the prostate and seminal vesicle. The procedure is usually carried out under the influence of general anaesthesia to avoid discomfort, however, if the patient has no nerve sensation, it can be carried out without the use of anaesthesia

Testis sperm retrieval

Testis Sperm Retrieval is an option when Penile Vibratory Stimulation (PVS) and Electro ejaculation (EEJ) fail to work. The sperm is directly collected from the reproductive tract, i.e. from the epididymis or testicles, using various methods that include:

1. Testicular Sperm Extraction (TESE) - It is a surgical procedure performed to extract sperm tissue directly from the seminiferous tubules of the male testes via tiny surgical incisions. The procedure is recommended to males having elevated levels of testosterone in their blood or do not respond to any treatment for azoospermia. The procedure is carried out under the influence of a nerve block injection, such that the patient does not feel any discomfort.

2. Testicular Sperm Aspiration (TESA) - Also known as Testicular Fine Needle Aspiration (TFNA), the procedure is somewhat similar to TESE, the only difference being that instead of making incisions, this involves the use of a thin needle which is punctured into the testes to gently extract the sperms.

3. TESA with Mapping - Multiple needle aspirations are performed throughout the testes so as to remove the sample tissue. The procedure may be used for people with Non-obstructive Azoospermia.

4. Microsurgical Epididymal Sperm Aspiration (MESA) - As the name suggests, it is a microsurgical procedure that is carried out to extract sperm from epididymis tubes. This enables the doctors to retrieve and save an ample amount of healthy sperm to be used later. The procedure is carried out under the influence of general anaesthesia and requires a very high degree of precision and expertise.

5. Percutaneous Epididymal Sperm Aspiration (PESA) - The procedure is carried out under the influence of general anaesthesia and involves the use of a needle and a syringe for gently extracting the sperm from the epididymis.

6. Microsurgical Testicular Sperm Extraction (Micro-TESE) - The procedure can only be opted by males suffering from non-obstructive azoospermia. It involves the opening of the outer cover of the testes for better access which in turn helps in precise and detailed examination. One of the greatest advantages of the procedure is that it ensures lesser damage to the blood vessels.