Surgical sperm recovery can collect sperm for use in in vitro fertilisation (IVF) or intrauterine insemination (IUI). Sperm can be harvested from different parts of the testes, vas deferens (the sperm duct) and/or epididymis (connecting the testicle and vas deferens) using either a small incision or a percutaneous needle.^1,9,31

Procedure types and acronyms include:³¹

·      Percutaneous epididymal sperm aspiration (PESA)

·      Microsurgical epididymal sperm aspiration (MESA)

·      Testicular sperm aspiration (TESA)

·      Testicular sperm extraction (TESE) - single or multi-site

·      Microscope-assisted testicular sperm extraction (MicroTESE).

Blockages in the sperm ducts flowing from the testicles may also be rectified with surgery. Options include a vasectomy reversal (depending on how recent the vasectomy was), microsurgical epididymo-vasostomy, or by removing scar tissue and opening up ejaculatory ducts.^1,9

While procedures will be conducted either under a local or general anaesthetic, pain and discomfort can last several days, and the man will be advised to use a suspensory bandage or scrotal support for one to two weeks.³²

Varicoceles are present in 35% of men with fertility problems, compared to 15% in men in general, and treatment of clinically relevant varicoceles can improve sperm number and quality. US and European urology guidelines now include this as an option to assist conception, but the NICE guidelines (last updated in 2017) still advise against this procedure.^1,9