At Yale Urology, we have a world class, state-of-the-art center for treatment of Azoospermia (no sperm in the ejaculate). Dr. Stanton Honig, director of the Male Sexual Medicine Program, will review your case and determine the best approach.
There are two groups of patients that may be candidates for sperm retrieval: those with obstruction, and those without obstruction (i.e. a problem with sperm production). Both scenarios are treated differently, and in most cases, patient history, a physical examination, and blood work can determine whether your case is obstructive or non-obstructive.
Cases of obstruction usually are a result of a prior vasectomy, absence of the vas deferens, or a blockage at the epididymis, a hernia repair site, or at the ejaculatory duct. Obstruction cases can be treated with either reconstructive surgery or sperm retrieval. In nearly all obstruction cases, sperm can be retrieved from the testis using a procedure called 'testis sperm aspiration or extraction' (TESE), or from the epididymis using microsurgical epididymal sperm aspiration (MESA).
In most cases, Dr. Honig performs these procedures in-office and under local anesthesia alone. In certain cases, sedation may be offered if the anatomy is unusual or if the patient prefers.
With one MESA, sperm can usually be obtained for multiple cycles of in vitro fertilization (IVF), which limits cost and discomfort. In a small number of cases, if epididymal sperm quality is borderline, Dr. Honig will perform TESE at the same time. In most cases, the procedure can be performed prior to starting an IVF cycle, which allows for confirmation of good sperm quality prior to incurring the costs of an IVF cycle. After the procedure, patients may require some pain medication and will require a few days off from work.