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What is Surgical Sperm Retrieval

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Infertility has become a common problem among couples worldwide, various factors contribute to the difficulties in conceiving. Factors such as male infertility including low sperm count, obstructive or non-obstructive azoospermia, or retrograde ejaculation contribute to the same. Our medical science provides hope by directly collecting sperm from the male reproductive tract, a specialised process called surgical sperm retrieval.

In this blog, you will get all the information about this procedure, different techniques of the procedure, when it is needed etc

What is Surgical Sperm Retrieval

When a man has azoospermia, a condition in which he has little or no sperm in his ejaculate.

A medical procedure called surgical sperm retrieval is used to directly obtain sperm from a man’s reproductive tract. It is beneficial for couples who struggle with male fertility to achieve pregnancy through assisted reproductive technologies (ART) like in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

Such conditions become a hurdle in achieving pregnancy where a man faces difficulties in the production of sperm. Urologists or IVF experts perform the procedure of extracting sperm from the male reproductive system.

When is surgical sperm retrieval necessary?

Surgical sperm retrieval is a process of extracting sperm from a man’s reproductive system in the case of low or no sperm production, which leads to issues in pregnancy and becomes very challenging for couples. In several scenarios, it becomes necessary to go for surgical sperm retrieval where natural conception is hindered due to male infertility issues.

Following are the main indications for when to visit the IVF centre for a surgical sperm retrieval procedure.

1. Obstructive Azoospermia

This condition is called when there is a blockage in the male reproductive system and is causing issues in sperm production with the semen. Due to these blockages, the sperm is unable to pass by.

It can occur through the congenital absence of the tube that carries sperm from the testicles to the urethra.

2. Non-obstructive Azoospermia

In such conditions, the amount of sperm produced is very low or no sperm is produced through the testicles of a man. It occurs due to genetic factors, testicular damage caused due to trauma or chemotherapy or due to hormonal imbalances.

You can go through infertility treatment including Testicular Sperm Extraction (TESE) to retrieve sperm directly from the testicular tissue.

3. Retrograde ejaculation

A condition in which semen enters the bladder and is not expelled through the urethra during ejaculation. Such is the scenario with people suffering from neurological conditions, previous surgeries if any or diabetic patients.

You need to visit the best fertility doctor to get the right treatment in such a case.

Techniques used in Surgical Sperm Retrieval.

Techniques used for Surgical Sperm Retrieval

There is a set of techniques, that have indications, considerations, and advantages based on the cause of male infertility. The choice of technique depends on the condition of a person and careful evaluation by the best fertility specialist.

Here are the Primary Techniques used in Surgical Sperm Retrieval:

1. Percutaneous Epididymal Sperm Aspiration (PESA)

This method involves sucking out sperm from the epididymis from a fine needle attached to a syringe. This technique is used for patients having obstructive azoospermia, where there is a blockage in the epididymis preventing sperm from reaching the semen.

It is a process that can be easily performed under local anaesthesia in an outpatient setting.

2. Testicular Sperm Aspiration (TESA)

A procedure when sperm production is impaired or absent within the epididymis or when epididymal sperm retrieval is not feasible. This technique involves a needle that extracts sperm directly from the testicle. It can be performed under local anaesthesia and is less invasive than other techniques.

3. Microsurgical Epididymal Sperm Aspiration (MESA)

It is a technique useful in cases in which the number of sperm needed is high or in the case where previous attempts with PESA were unsuccessful. High powered surgical microscope is used in performing such a technique, a small incision in the scrotum is made to directly visualize the epididymis. The fertilization specialist then identifies the sperm and extracts it from the epididymal tubules.

In this technique, there is less chance of damage to surrounding tissues and it also allows precise identification and retrieval of sperm.

4.  Testicular Sperm Extraction (TESE)

TESE is used in the cases of patients having non-obstructive azoospermia, a condition that includes impaired or low sperm production within the testicles. It is a feasible technique that involves retrieval of sperm directly from the testicular tissue, by removing a small piece of testicular tissue through a minor surgical procedure and then is sent to the laboratory to examine the areas containing sperm.

5. Microdissection TESE (Micro-TESE)

Such a technique is perfect for cases of severe non-obstructive azoospermia, where there are extreme impairments in sperm production. It is performed under higher magnification as it is a specialized form of TESE. The goal of this technique is to lower the trauma to the testicular tissue and increase the retrieval of sperm.

RISKS INVOLVED!

Risks involved in such IVF procedures are minimised when performed in top fertility clinics. And is generally a safe and effective procedure performed under the proper supervision of the experts.

However, there can be risks involved like any other surgical procedure.

The following are the factors that should be considered before proceeding with the procedure:

  1. Infection
  2. Bleeding
  3. Discomfort and pain
  4. Damage to surrounding tissues
  5. Anaesthetic risks

FREQUENTLY ASKED QUESTIONS!

1. Is surgical sperm retrieval painful?

It is relatively a less painful procedure involving a fine syringe being inserted in the epididymis or the testicle to extract the sperm performed under local anaesthesia.

2. How successful is surgical sperm retrieval?

In patients with obstructive azoospermia, there is a very high chance of recovering sperm by this method (>90%). Whereas in patients with non-obstructive, the chances are 40%.

3. What is the difference between TESA and TESE?

TESA= no incision or surgery required in TESA, only the needle is inserted under local anaesthesia with very low pain, low time and low charges. Whereas in TESE, biopsy surgery is done to extract tissue under General anaesthesia.

4. What are the side effects of PESA and TESA?

Side effects of PESA and TESA include mild swelling or bruising at the site of the procedure which usually resolves within a few days.

5. What are the signs of low sperm count?

Decreased facial or body hair, inability to impregnate women, pain or swelling in the testicle area, and difficulty maintaining an erection can be the symptoms of low sperm count.

Why Choose Us?

Choosing our clinic Imprimis IVF for surgical sperm retrieval will turn out to be the best decision when it comes to your reproductive health because we ensure compassionate care with a team of highly experienced professionals. We are equipped with advanced technologies to tailor to your unique fertility needs and provide treatment accordingly.

We understand this emotional challenge and hence provide a supportive environment and transparent communication to help you gain the trust and confidence in choosing us. Our clinic provides expert care and personalised attention throughout your journey to parenthood.  We have a track record of successful procedures, providing reassurance and support at every step.

ICSI Treatment for Infertility: Procedure, Benefits, Cost & Success Rate

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ICSI Treatment for Infertility: Infertility does not always mean that a couple needs the same treatment. The cause of infertility can differ from one couple to another, and treatment is selected after evaluating factors such as age, reproductive health, ovarian reserve, sperm quality, medical history and previous fertility treatments.

Intracytoplasmic Sperm Injection (ICSI) is an advanced assisted reproductive technology that can be particularly useful when male-factor infertility affects fertilisation.

During ICSI, an embryologist injects a single selected sperm directly into a mature egg using specialised laboratory equipment. The resulting embryo may then be cultured and transferred to the uterus as part of an IVF treatment cycle.

In this guide, we explain what ICSI is, who may benefit from it, how the ICSI procedure works, its benefits, limitations, cost, success rate and how it differs from conventional IVF.

At Imprimis IVF & Fertility Centre, Srinagar, our fertility team provides personalised fertility evaluation and treatment based on each couple’s individual needs.

What Is ICSI?

ICSI stands for Intracytoplasmic Sperm Injection.

It is a laboratory fertilisation technique used in an IVF cycle. Instead of placing sperm and eggs together and allowing fertilisation to occur naturally in the laboratory, an embryologist uses a very fine injection pipette to introduce a single sperm directly into a mature egg.

ICSI may be considered when there is a significant risk of difficulty with fertilisation, particularly in cases of male-factor infertility.

Importantly, ICSI is not a separate alternative to IVF in the same way that IUI is. ICSI is generally performed as part of an IVF treatment cycle.

Who May Need ICSI Treatment?

ICSI is not necessary for every couple undergoing fertility treatment. Your fertility specialist and embryology team may consider ICSI depending on the cause of infertility and the couple’s treatment history.

ICSI may be considered in situations such as:

  • Very low sperm count
  • Poor sperm motility
  • Severe abnormalities in sperm morphology
  • Previous IVF cycle with low or failed fertilisation
  • Sperm obtained through a surgical retrieval procedure
  • Certain cases of azoospermia where sperm can be surgically retrieved
  • Use of previously frozen sperm in selected situations
  • Certain situations involving fertility preservation
  • Some cases where assisted fertilisation is considered appropriate based on the treatment plan

The decision should be individualised rather than based solely on a single semen-analysis result.

How Does ICSI Work?

Although ICSI is often described as a single sperm-injection procedure, it usually takes place within a broader IVF cycle.

The treatment generally involves several stages.

1. Ovarian Stimulation

The woman receives fertility medications to stimulate the ovaries and encourage the development of multiple follicles.

During this stage, the fertility team monitors follicular growth using ultrasound scans and, when appropriate, blood tests.

The exact medication protocol and duration vary depending on the patient’s age, ovarian reserve, medical history and treatment plan.

2. Trigger Injection

When the follicles have developed sufficiently, the doctor administers a trigger medication to help the eggs complete their final stage of maturation.

The clinic then schedules egg retrieval for the appropriate time before spontaneous ovulation.

3. Egg Retrieval

Egg retrieval, also known as oocyte retrieval or ovum pickup (OPU), is performed under ultrasound guidance.

A fine needle is passed through the vaginal wall into the ovaries to collect fluid containing the eggs.

The procedure is generally performed under sedation or anaesthesia, depending on the clinic’s protocol and the patient’s circumstances.

The embryology laboratory then assesses the collected eggs.

4. Sperm Collection and Preparation

The male partner usually provides a semen sample on the day of egg retrieval.

In some cases of severe male-factor infertility, sperm may need to be obtained using a surgical sperm-retrieval technique.

Depending on the individual case, techniques may include:

  • TESA – Testicular Sperm Aspiration
  • TESE – Testicular Sperm Extraction
  • PESA – Percutaneous Epididymal Sperm Aspiration
  • MESA – Microsurgical Epididymal Sperm Aspiration
  • Micro-TESE – Microdissection Testicular Sperm Extraction

The embryology team then processes the sample and selects suitable sperm for ICSI.

5. Intracytoplasmic Sperm Injection

This is the key laboratory step of ICSI.

The embryologist identifies a suitable sperm and carefully holds it with a specialised micropipette.

The embryologist then injects the sperm directly into a mature egg using a microscopic injection system.

The eggs are subsequently monitored to determine whether fertilisation has occurred.

6. Embryo Development

Successfully fertilised eggs begin to divide and develop into embryos.

Embryologists monitor embryo development over the following days.

Some embryos may reach the blastocyst stage around day 5 or 6. Depending on the treatment plan, the clinic may transfer the embryo at an appropriate developmental stage or freeze it for future use.

Not every fertilised egg will necessarily develop into a transferable embryo.

7. Embryo Transfer

When a suitable embryo is selected for transfer, a thin catheter is used to place it into the uterus.

Embryo transfer is generally a short procedure and usually does not require anaesthesia.

The number of embryos transferred depends on factors such as the patient’s age, embryo quality, medical history and applicable clinical recommendations.

In many situations, single embryo transfer may be preferred to reduce the risk of multiple pregnancy.

Who Can Benefit From ICSI for Male Infertility?

ICSI is particularly relevant when problems with sperm quantity or quality may make fertilisation difficult.

Low Sperm Count

Oligozoospermia refers to a lower-than-expected sperm concentration in semen. Severe reductions in sperm count may make conventional fertilisation more difficult.

Azoospermia

Azoospermia means that sperm are not detected in the ejaculate.

Some men with azoospermia may still have sperm that can be retrieved directly from the testicles or epididymis and used for assisted reproduction.

Poor Sperm Motility

When sperm have reduced movement (asthenozoospermia), reaching and fertilising the egg can be difficult.

ICSI bypasses several steps sperm must take to naturally reach and penetrate the egg.

Abnormal Sperm Morphology

Teratozoospermia refers to a high proportion of sperm with abnormal morphology.

ICSI allows the embryologist to select an individual sperm for injection, although sperm morphology alone does not automatically mean ICSI is required.

Previous Fertilisation Failure

ICSI may also be considered when a previous IVF cycle resulted in unexpectedly low or complete fertilisation failure.

What Are the Benefits of ICSI?

Potential advantages of ICSI include:

  • It can help overcome certain severe male-factor infertility problems.
  • It can be used when only a small number of sperm are available.
  • It may allow the use of surgically retrieved sperm in selected cases.
  • It can help overcome previous fertilisation failure in appropriate situations.
  • It gives the embryologist direct control over the sperm-injection step.

However, ICSI does not guarantee fertilisation, embryo development, implantation or pregnancy.

Does ICSI Increase IVF Success?

One important point patients should understand is that ICSI is not automatically associated with a higher pregnancy rate for every couple.

Its main purpose is to improve the likelihood of fertilisation in situations where conventional IVF may have difficulty achieving fertilisation.

The overall outcome of IVF/ICSI depends on many factors, including:

  • Woman’s age
  • Egg quality
  • Ovarian reserve
  • Sperm quality
  • Embryo quality
  • Uterine and endometrial factors
  • Underlying fertility conditions
  • Previous treatment history
  • Laboratory and embryology factors

Therefore, a fertility specialist should assess the complete clinical picture before recommending ICSI.

ICSI vs IVF: What Is the Difference?

Both IVF and ICSI involve ovarian stimulation, egg retrieval, laboratory embryo development and embryo transfer.

The major difference occurs during fertilisation.

Conventional IVF ICSI
Eggs and prepared sperm are placed together in the laboratory A single sperm is injected directly into a mature egg
Fertilisation occurs without direct sperm injection Embryologist performs direct sperm injection
Often used when sperm parameters are adequate Often considered when fertilisation may be difficult
Does not require sperm injection Requires specialized micromanipulation

ICSI is a fertilisation technique used within an IVF cycle, not simply a replacement for IVF.

ICSI Treatment Cost in India

Costs vary considerably depending on the clinic, city, medicines, diagnostic tests, laboratory procedures, and whether additional treatments are required.

The total cost may be influenced by:

  • Ovarian stimulation medicines
  • Egg retrieval
  • Embryology and laboratory charges
  • ICSI procedure
  • Anaesthesia or sedation
  • Embryo culture
  • Embryo freezing
  • Frozen embryo transfer
  • Additional diagnostic procedures
  • Sperm retrieval procedures, when required

For this reason, it is better to obtain an individualised treatment estimate after fertility evaluation rather than relying on a single fixed ICSI price.

For patients seeking ICSI treatment in India, a fertility consultation can help determine which investigations and treatment components are appropriate.

How Long After ICSI Can Pregnancy Be Confirmed?

After embryo transfer, a pregnancy test is generally performed according to the fertility clinic’s recommended schedule.

The exact timing depends on the embryo type transferred and the clinic’s protocol.

A beta-hCG blood test is commonly used to confirm pregnancy because it can provide a more reliable early result than a home urine pregnancy test.

Patients should follow the testing date their fertility team provides rather than testing too early.

Is ICSI Better Than IVF?

Not necessarily.

ICSI may be more appropriate when there is a significant risk of fertilisation problems, particularly with certain forms of male-factor infertility or previous fertilisation failure.

For couples without a clear indication for ICSI, conventional IVF may be an appropriate option.

The choice between conventional IVF and ICSI should be based on the couple’s fertility evaluation, medical history and clinical circumstances.

Frequently Asked Questions About ICSI Treatment for Infertility

Is ICSI only for male infertility?

No. Although ICSI is particularly useful in many cases of male-factor infertility, it may also be considered in other situations, such as previous fertilisation failure or specific treatment circumstances.

Is ICSI painful?

The sperm-injection procedure itself is performed in the embryology laboratory and is not felt by the woman. However, ovarian stimulation and egg retrieval are separate parts of the IVF cycle and may involve medications, discomfort or sedation.

Can ICSI be used when there are very few sperm?

Yes. In selected cases, ICSI can be performed when only a limited number of viable sperm are available. Surgical sperm retrieval may also be considered in some men.

Can ICSI treat azoospermia?

ICSI may be possible for some men with azoospermia if viable sperm can be retrieved from the testicle or epididymis. First, the underlying cause of azoospermia needs to be evaluated.

Is ICSI 100% successful?

No. ICSI does not guarantee fertilisation, embryo development or pregnancy. Outcomes depend on multiple factors, particularly egg and sperm quality, age and embryo development.

How many embryos are transferred after ICSI?

The number depends on individual circumstances and clinical recommendations. In many cases, transferring a single suitable embryo can help reduce the risk of multiple pregnancy.

Final Thoughts: ICSI Treatment for Infertility

ICSI can be an important fertility treatment option for couples facing certain fertilisation and male-factor infertility problems. By injecting a selected sperm directly into a mature egg, ICSI can help overcome some of the barriers that may prevent fertilisation during conventional IVF.

However, ICSI is not required for everyone undergoing IVF. The most appropriate treatment depends on the underlying cause of infertility, fertility history, age, egg and sperm factors and other clinical considerations.

At Imprimis IVF & Fertility Centre, our fertility specialists and embryology team evaluate each couple individually and recommend treatment based on their specific fertility needs.

If you are experiencing low sperm count, poor sperm motility, abnormal sperm morphology, azoospermia, previous IVF fertilisation failure or unexplained infertility, consult a fertility specialist to understand whether ICSI may be appropriate for you.