Epididymal and Testicular Sperm Aspiration

Surgical retrieval of sperm from the epididymis or testicle can sometimes be performed in men who have no sperm in their ejaculate (azospermia). Obstruction in the male reproductive tract is a common cause of azospermia. The most common causes of obstructive azospermia include the following: prior vasectomy, congenital absence of the vas deferens, infection and trauma. These men produce sperm, but due to the blockage, no sperm are found in the ejaculate. Sperm can usually be retrieved by aspiration of the epididymis or the testicle. The aspiration procedure is performed by a urologist under local anesthesia in the office. The quantity and quality of the sperm are such that IVF with intra-cytoplasmic sperm injection (ICSI) is necessary to achieve a pregnancy. It should be noted that men with congenital absence of the vas deferens are usually genetic carriers for the disease cystic fibrosis. They are at risk for producing offspring with the full cystic fibrosis disease. It is recommended that the female partner of these men be screened for the cystic fibrosis carrier state.

Some men have azospermia due to inadequate or absent sperm production in the testicles. This is called non-obstructive azospermia and it is more difficult to treat than obstructive azospermia. Viable sperm cannot always be retrieved from these men. Testicular aspiration can be attempted and if viable sperm are recovered, IVF with ICSI can be used to attempt pregnancy.