Surgical sperm retrieval
Some men who had been through a vasectomy previously or have an obstruction in their spermatic ducts will have no sperm in their ejaculate. Thus their sperm has to be surgically retrieved either from the epididymis or the testicles.
MESA and TESE
When the sperm is taken from the epididymis it is called micro-epididymal sperm aspiration (MESA), and when it is retrieved from the testicles it is called Testicular sperm extraction (TESE).
The MESA is significantly more expensive than the TESE. The TESE procedure extracts a lower number of sperm compared to the MESA but the quality and quantity is sufficient for at least one cycle of IVF.
Testicular sperm has very poor motility and must be combined with the ICSI procedure to fertilise an egg. Both procedures require general anaesthesia, surgical incisions and a hospital stay of 1 to 2 days.
WATCH: Doctor explains the different types of surgical sperm retrieval in detail