Sperm retrieval

In vitro fertilization is normally performed using sperm from a semen sample. However, for men who have a low sperm count or no sperm in their ejaculate, it may still be possible to retrieve some sperm. Some men with no sperm are actually making sperm that can't get out--either the men have had vasectomies or they have a blockage that prevents sperm from leaving the testicle. Only one sperm is needed to perform intracytoplasmic sperm injection (ICSI) and in many cases a doctor can extract hundreds of sperm directly from the testicle.

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The most common technique uses a thin needle. Under local anesthesia, a doctor inserts the needle into the epididymis, a structure that sits on top of the testis and holds sperm while they mature. The procedure only takes a few minutes, including the time to inject anesthetic. He extracts fluid from the epididymis and an embryologist immediately checks the fluid to make sure it contains sperm.

If there is no sperm in the epididymis, the doctor can use a biopsy gun, which shoots a needle into the testicle itself and takes a sample of the tissue and sperm. The doctor may take several samples. After extraction with a fine needle or a biopsy gun, the man should be back to normal activities the next day.

If neither of these techniques works, the doctor may take a larger wedge of the testicle. This requires making a small incision in the scrotum, which means recovery will be longer and more painful.