In order to analyse the health of a man’s semen, sperm must be extracted. Sperm can be extracted in many ways with the most common method involving the collection of a freshly ejaculated sample. A sperm sample is then taken to a laboratory for investigation under a microscope to determine the number, shape, and movement of sperm.
In some cases, a man may be unable to release or produce sperm naturally. Surgical sperm extraction is one of the most common procedures performed to collect sperm for analysis.
Fine needle or open microscopic testicular sperm extraction can be performed to extract sperm directly from a man’s reproductive system.
Fine needle sperm extraction can be achieved under local anaesthetic. TESA (Testicular Sperm Aspiration) involves passing a fine needle directly into a man’s testis to extract sperm. PESA (Per-Epididymal Sperm Aspiration) involves passing a fine needle into a man’s epididymis, the storage depot for mature sperm that sits on top of the testis. Both these methods are suitable for a man who is producing sperm but has a blockage so that sperm cannot escape into the ejaculated semen. Examples include after a man has had a previous vasectomy procedure, when he is born without a vas deferens (CBAVD, Congenital Bilateral Absence of the Vas Deferens) or has had a sexually transmitted infection (STI) like chlamydia or gonorrhoea.
Open testicular biopsy is another method of sperm extraction, performed under a general anaesthetic. This procedure is performed by first making a small incision in the testicle and removing a very small amount of tissue. This piece of removed tissue is examined under a microscope by a specialist to look for any sign of sperm.
Microtese refers to a more complicated testicular biopsy procedure, performed when the testis is seriously failing to make sperm and looking for tiny clusters of sperm making cells. Microtese involves a fine-tooth comb approach, looking through every part of the testis with a very high powered microscope. This can take many hours and is performed under general anaesthetic. Microtese requires subsequent testicular reconstructive surgery and is generally performed in collaboration with a fertility focused urologist (male genital surgical specialist)
After sperm is removed from the testes, it can be used straight away to fertilise an egg. In many cases, if enough sperm is retrieved, this sperm can also be frozen and stored to be used at a later time for future infertility treatment.
Andrology is the study of functions and diseases that affect the health of male reproductive organs. Think of it as the male equivalent of gynaecology for women. Healthy habits and regular checkups can drastically improve a couple’s chances of conceiving. That’s why understanding what affects male reproductive health is vital for any couple hoping to conceive.
It is often recommended that couples should visit a CREI fertility specialist after trying to conceive for an extended period of time. A Certified Reproductive Endocrinologist and Infertility (CREI) specialist has been dual certified by the Royal Australia and New Zealand College of Obstetrics and Gynaecology as both and Obstetrician/Gynaecologist and a subspecialist Reproductive Endocrinologist, fully trained as an Andrologist as well as being a female infertility specialist. As age can be a factor in male reproductive health, not everyone has the luxury of time to waste. There is nothing wrong with visiting a CREI andrology specialist in the early stages of your attempts to conceive a child. The earlier you identify reproductive health issues, the sooner they can be treated and in some cases, reversed.