Sperm can be obtained directly from the testis using testicular biopsy (TESE). The most common reason for this procedure to be undertaken is the obstruction to the sperm transport system. As a result, no sperm are present in the ejaculate, however, large numbers of sperm may still be produced in the testis. This situation can be congenital or can follow scarring and blocking of the fine tubules that lead from the testis as a result of infection or after vasectomy.
In most patients, a fine needle biopsy is performed. Local anesthetic is used to induce numbness in the testis. The needle is placed through the skin into the testis and a small piece of tissue is removed. The embryologist then examines the fine tubes contained in the biopsy sample and removes sperm for the microinjection procedure (ICSI). The fine needle biopsy takes about fifteen minutes. Occasionally extra sperm can be frozen and used for subsequent microinjection cycles. Alternatively the biopsy can be performed again. The results of the microinjection procedure using testicular sperm in such cases are good (approximately 41% clinical pregnancy rate per retrieval).
In cases where no sperm are found, couples must consider whether to freeze the eggs or use donor sperm.