- Percutaneous Epididymal Sperm Aspiration (PESA)
- Testicular Sperm Extraction (TESE)
- Micro-epididymal Sperm Extraction (MESE)
- Testicular Biopsy
These procedures are available for men who cannot ejaculate or have no sperm in the ejaculate but can still produce them in the testicles. These situations may be the result of previous vasectomy (male sterilization), congenital obstruction of the sperm ducts (vas deferens) which carry the sperm away from the testicles where they are made, congenital absence of the vas deferens due to Cystic Fibrosis, or to inadequate development of the sperm such that they cannot leave the testes. In many of these situations, an urologist, specially trained in male infertility, can harvest sperm directly from the male genitalia by placing a needle into the testis or the tubes that drain it. In more challenging cases, tissue from the testicle may be biopsied in hopes that the embryologist may find viable sperm within the testicular tissue itself, if it cannot be found with regular extraction methods. All of these procedures are done under local or general anesthesia and can be very effective in yielding a pregnancy when combined with advanced reproductive techniques such as IVF with ICSI.