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Some men are infertile because they have either low levels or a complete absence of sperm in their ejaculate. In such cases, they may request sperm retrieval to help them conceive with a female partner, because using medical procedures to draw out sperm can increase their chances of conception during processes such as in vitro fertilization (IVF). Sperm can be taken from either the testicles or the epididymis, and there are a few different ways of going about it. Some require an incision in the scrotum, while others involve using a needle to draw out sperm.
Sperm retrieval is helpful for men who have a low sperm count or motility problems, allowing them a chance to reproduce when their sperm is not able to impregnate a woman naturally. Other men opt for this procedure after a vasectomy, especially if a vasectomy reversal is ineffective, because it may allow them to have children despite having had surgery to prevent reproduction. In other cases, sperm may have to be retrieved because the vas deferens is missing or the seminal tract is blocked. In general, as long as the male produces some sperm, he can use this procedure to help him reproduce, though it is not always successful.
One of the main methods of sperm retrieval is microsurgical epididymal sperm aspiration (MESA). In this process, an incision is made in the epididymis so sperm can be withdrawn. The epididymis is usually the preferred place to harvest sperm, because the semen taken from this area of the body tends to react the best to cryopreservation, in which sperm is frozen for future use.
A less invasive — and often less successful — procedure is percutaneous epididymal sperm aspiration (PESA), which uses a needle to aspirate sperm without requiring an incision in the scrotum. Sperm also can be taken from the testicles when there is not much in the epididymis, but the sperm in this area can be harder to freeze. The process of taking sperm from the testicles is called testicular sperm extraction (TESE). It involves cutting a tiny bit of tissue from the area and collecting any sperm on the sample.
After sperm retrieval, which tends to be an outpatient procedure, a number of medical procedures may follow before conception results. For example, during IVF, the egg and sperm are removed from the couple and then joined in a tube so conception is more likely. The procedure with the highest success rate, though, tends to be intracytoplasmic sperm injection (ICSI), in which a single sperm is injected into an egg. This is technically considered a type of IVF and is usually the most likely method to result in conception after sperm retrieval.
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