GCRM-BELFAST: Clinical Manual: INF-Clin030-20160920
Surgical Sperm Retrieval
(SSR)
Information Leaflet
Authorised by: Dr I Agbaje – Medical Consultant
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GCRM-BELFAST: Clinical Manual: INF-Clin030-20160920
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Surgical Sperm Retrieval
What is surgical sperm retrieval (SSR)?
SSR is a technique for collecting sperm from a testicle. It is a minor procedure, usually carried out as a day
case under local or general anaesthetic.
Who needs SSR?
SSR is intended to help men who have no sperm in their ejaculate. This can be the result of vasectomy, a
blockage in the vas deferens (the tube which carries the sperm to the penis), an absent vas deferens, a
blockage in the epididymis, (the structure connecting the testis to the vas deferens), or because the testicles
are producing only extremely small amounts of sperm. Most of these men produce healthy sperm which can
be retrieved by SSR. Unfortunately, some men have testicles that fail to produce any sperm at all and SSR
is not a suitable procedure for this condition.
For men who have had a vasectomy another option may be vasectomy reversal. This is an operation which
aims to restore fertility by reconnecting the tubes (called the vasa deferentia) that carry sperm from the
testicles to the penis.
Types of SSR
There are a few different types of SSR and the cause of the sperm problem will determine which procedure
is most suitable for you.
Testicular Sperm Extraction (TESE)
A small incision is made in the skin overlying the testicle and a special needle is used to remove a small
sample of tissue. This is examined in the laboratory for the presence of sperm. This procedure may cause
some pain, tenderness and localised bruising. However, full recovery is usual within a few days.
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA is a short, relatively painless procedure and requires no surgical incision. A fine needle is inserted into
the epididymis through the scrotum and fluid aspirated. This fluid is then inspected under a microscope for
sperm.
It is important to inform the doctor or nurse if you are taking any medication, particularly drugs like
Aspirin or Plavix, which may increase your risk of bleeding. MEDICATIONS LIKE THESE USUALLY
NEED TO BE STOPPED A FEW DAYS PRIOR TO ANY PROCEDURE.
As this procedure may be performed with sedation, you will need to fast at least 6 hours beforehand.
In men who produce very small amounts of sperm, a more advanced ‘micro-surgical’ SSR technique is
required (Micro-TESE & MESA (Microsurgical Epididymal Sperm Aspiration)). These types of SSR are
performed under a general anaesthetic in the Ulster Independent Clinic using an operating Microscope.
What to expect afterwards?
In the case of TESE or PESA performed under local anaesthetic and/or sedation, there will usually be no
sutures. The procedure takes 10-15 minutes and the local anaesthetic will give pain relief for 2- 3 hours. Side
effects may include some testicular discomfort and mild bruising.
Any sedation will wear off quickly, but someone will need to drive you home. Occasionally, if no sperm are
obtained, the biopsy may need to be repeated on the other side. After the procedure, you will be given
antibiotics to protect against infection.
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You will need to rest until the effects of the sedation have worn off. Your scrotum may feel
uncomfortable as the anaesthetic wears off but you will be given painkillers.
You will need to wear supportive underwear to help relieve any discomfort.
You will normally be able to go home after you have passed urine.
Authorised by: Dr I Agbaje – Medical Consultant
GCRM-BELFAST: Clinical Manual: INF-Clin030-20160920
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You will need to arrange for someone to drive you home. You should try to have a friend or relative
stay with you for the first 24 hours.
 Your nurse will give you advice about caring for the healing wound, hygiene and bathing before you
go home.
If you need additional pain relief, you can take over-the-counter painkillers such as Paracetamol or Ibuprofen.
Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist
for advice.
Drugs used for sedation can temporarily affect your co-ordination and reasoning skills, so you shouldn't drink
alcohol, operate machinery or sign legal documents for 24 hours afterwards.
Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform
an emergency stop without discomfort.
Continue to wear close-fitting underwear day and night for a week. This will help ease any discomfort and
swelling.
You can bathe and shower but you should dry the area gently and thoroughly afterwards.
You can have sex as soon as you feel comfortable.
What are the risks?
SSR is a commonly performed and generally safe procedure. However, in order to make an informed decision
and give your consent, you need to be aware of the possible side-effects and the risk of complications of this
procedure.
Possible Side-effects
These are the unwanted, but mostly temporary effects of a successful procedure, for example feeling sick as
a result of the sedation.
Your scrotum may feel uncomfortable and you may have some bruising and swelling for a few days.
Possible Complications?
This is when problems occur during or after the operation. Most men are not affected. The possible
complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding,
infection, or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). Infection is
usually treated with antibiotics. Specific complications of SSR are uncommon, but can include:
Bleeding inside your scrotum (haematoma) - this may need surgery to stop the bleeding and drain the area
Fluid building up in your scrotum (hydrocele) - this may need treatment to drain the area
Damage to blood vessels - this can cause permanent damage to one or both testicles (testicular atrophy)
Long-term testicular pain - this is caused by pinched nerves or scarring and may need surgery. A rare but
important risk of this procedure is the need to remove a testicle because of bleeding or infection.
Effectiveness of SSR
Sperm retrieved from the testicle are either used in treatment on the same day, or frozen for use in the future.
This does not affect their ability to subsequently fertilise an egg. The sperm retrieved are usually low in
number, and may not be mature, and therefore cannot successfully fertilise an egg using IVF. The
embryologist will thus pick out a single sperm to inject into each egg; this procedure is called Intracytoplasmic
Sperm Injection (ICSI) and there is a separate charge. If only non-motile sperm are available for selection,
it may be difficult to determine which sperm are alive or dead, so fertilisation rates will be adversely affected.
It is also possible that no sperm are obtained.
Authorised by: Dr I Agbaje – Medical Consultant
GCRM-BELFAST: Clinical Manual: INF-Clin030-20160920
Recommended Treatment Journey
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You may already have had a semen analysis which indicates the need
for SSR
Arrange for Ovarian Assessment for partner
(If Female is 37 years or over and/or has and AMH value of less than
7.0 pmol/L we strongly recommend seeing a GCRM-BELFAST Fertility
Specialist before progressing to the Surgical Sperm Retrieval)
Arrange an appointment with the doctor at GCRM-B
Arrange all necessary blood tests as requested by the doctor
(including but not exclusively: HIV, Hep C, Hep B Surface Antigen and
Hep B Core Antibody, FSH & Testosterone, Karyotype, AZF and CF
Status)
When results are back contact the Nurses at GCRM-BELFAST, who
will co-ordinate a date for the procedure
Arrange consent appointment with GCRM-BELFAST for procedure
Pay for procedure
Procedure date and time will be confirmed in writing
Procedure
Authorised by: Dr I Agbaje – Medical Consultant
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