How does the male reproductive system work?
The testes have two functions: to produce the hormone, testosterone, and to produce sperm. The production time for mature sperm is 2-3 months, and many millions reach maturity every day. They are slowly pushed forward by the pressure of new sperm produced behind them, initially into collecting channels (the rete testis and efferent ducts) and then into the epididymis. The epididymis is a single, very fine tightly coiled tubule, which if stretched out would measure several metres in length. During their slow passage through the epididymis the sperm continue to mature and they only develop full motility when they reach the vas deferens. This is a larger and more muscular tube about the same thickness as a strand of spaghetti. (The vas deferens is the tube which is cut and tied in the male sterilisation operation called vasectomy). The vas deferens acts as the main site of storage of mature motile sperm and its muscular function is to ejaculate the stored sperm.

Why is surgical sperm recovery necessary?
One reason is that sperm formed in the testes may be blocked by, for example, a vasectomy, or scarring due to infection, or by the developmental absence of the vas deferens. However, sperm can accumulate in the epididymis and it is possible to collect them using a fine needle. A different type of problem is the lack of sperm production within the testes, so-called spermatogenic failure. There may be too few sperm produced to appear in the ejaculate but in about half of cases it is possible to collect sperm from the testis itself.

The number of sperm which can be collected in this way is usually too low for use in IVF and Intracytoplasmic Sperm Injection (ICSI) is needed.

What is involved in surgical sperm recovery?
This may be done on the same day as egg collection earlier in the morning or it may be done as an elective procedure. The surgical sperm recovery procedure is usually done as a day-case procedure under local or general anaesthetic.

It is important that you don't eat or drink any fluids after midnight the night before the operation. You should be able to leave the hospital about 6 hours after the operation and resume full normal physical activities after 4 or 5 days. We would advise you to bring some Y-front or similar supportive underpants such as a jock strap, with you to the hospital and to wear these continuously for 48 hours after your operation to minimise any discomfort and protect your scrotum and testes.

The type of sperm recovery procedure will depend on the nature of your problem. If it is due to a blockage, we will first try to collect sperm from your epididymis using a fine needle and syringe. This technique is called Percutaneous Epididymal Sperm Aspiration (PESA). If this fails we would take a biopsy of testicular tissue (Testicular Sperm Extraction - TESE), a small incision is made in your scrotum to gain access to one of your testes. If you have spermatogenic failure we would need to go straight to testicular biopsy, and we may need to take more than one tissue sample to be able to find any sperm. After the biopsy, the incision will be repaired using stitches which dissolve and will not need to be removed.

It is not always possible to recover sperm, particularly from men with spermatogenic failure. If unsuccessful, there are two options:-

• Abandon the scheduled egg collection for ICSI treatment,
  
  
• Proceed with standard IVF using donor sperm

We will discuss these options with you at your initial consultation so that you have time to consider them carefully and undergo the counselling needed if you want the option of using donor sperm. We would need to know your wishes and intentions well before the start of treatment leading up to IVF/ICSI.

How successful is surgical sperm recovery for ICSI?
Surgical sperm recovery and ICSI are rapidly developing techniques and relatively large numbers of results are needed to give established success rates. We will discuss our latest results with you at your consultation. The results we have achieved so far with surgically recovered sperm are virtually the same as we get from ICSI in other cases using ejaculated sperm.

What are the possible complications of this procedure?
The risk of a complication is small and most men will usually only get some mild discomfort or aching for a couple of days which can be relieved by taking aspirin or paracetamol However, despite every precaution, complications can follow any operation. The commonest complications are:

• Infection - which usually causes increased tenderness and there may be a cloudy discharge from around the dissolvable stitches in your scrotum
  
  
• Haematoma (collection of blood) within the scrotum. This will usually cause a swelling and deep purple discolouration, but the risk of this is minimised by you wearing firm supportive underwear night and day for 48 hours after your operation.

Both of these complications are likely to cause pain initially, usually within 2-4 days after the procedure. If you suspect that either of these problems is developing you should contact The Hewitt Centre or your own GP.