Shane T. Russell, MD

Sperm extraction procedures

Why would sperm need to be extracted?

Sperm extraction procedures are used in patients who do not have enough good quality sperm in the ejaculate to be used for in-vitro fertilization (IVF).  Reasons for this include a blockage of the structures that transport sperm (called ‘Obstructive’ reasons) or failure of the testicles to make enough sperm to have them ‘spill over’ into the ejaculate (called ‘Non-Obstructive’ reasons).  The sperm retrieved surgically are not mature enough or numerous enough to use in intrauterine insemination (IUI), but must be used in conjunction with IVF. 

When are sperm extractions typically performed?

These procedures are typically performed several weeks or months prior to the time when the female partner’s eggs are retrieved for IVF.  Advantages of doing the extraction procedure beforehand include easier planning of timing for the couple, as well as avoiding the need for both partners to have a procedure at the same time (so they can better assist each other in post-operative care).  Sperm retrieved beforehand are frozen at the time of extraction and then thawed at the time of the egg retrieval.  While it is true that at least 50% of the sperm do not survive the freeze/thaw process, only 10-20 healthy sperm are typically needed for an IVF/ICSI cycle.  In most patients, hundreds or thousands of sperm are obtained with the sperm extraction procedure, so the freezing and thawing of sperm does not present a problem. 

How and where are sperm extractions done?

Sperm extraction procedures are typically performed on an outpatient basis in a clinic procedure room under local anesthesia, though this may differ depending on specific clinical situations.  Sperm are typically extracted from the testicle, but can also sometimes be taken from the epididymis, which is the structure that wraps around the side and back of the testicle where the sperm mature before entering the vas deferens (which then carries sperm to the urethra during ejaculation).  The extraction can be done percutaneously (with a small needle through the skin without any incisions) or an ‘open’ technique through a small (approximately 2cm) incision in the scrotum.  Percutaneous procedures are faster and tend to have less post-operative inflammation, but typically retrieve less sperm. The decision about the right procedure for you depends on your specific clinical circumstances, which will be discussed with you in detail.

How successful are sperm extraction procedures?

Success rates for sperm extraction depend on the cause of the very low or non-existent sperm counts in the ejaculate.  Patients with obstructive (blockage) reasons for very low or no sperm usually have good sperm production by the testicles, and therefore sperm extraction procedures have a greater than 95% chance of finding adequate numbers of sperm. 

Patients with non-obstructive reasons have lower rates of success which vary depending on certain individual clinical fertility parameters of the patient.  Techniques such as FNA (fine needle aspiration) mapping of the testicle and microTESE (microscopic testicular sperm extraction) are two cutting-edge techniques offered by Dr. Russell in order to optimize sperm retrieval outcomes in these patients.