Sperm Retrieval Surgery in Singapore

For couples facing male factor infertility, the journey to parenthood can feel overwhelming. When conventional methods cannot obtain viable sperm for assisted reproduction, sperm retrieval surgery offers hope by directly extracting sperm from the reproductive system. This procedure has helped many couples in Singapore achieve their dream of starting a family, particularly when combined with in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Our MOH-accredited urologists specialise in various sperm retrieval techniques, providing personalised solutions based on each patient’s situation.

Sperm retrieval surgery encompasses several surgical techniques designed to obtain viable sperm directly from the male reproductive system when sperm cannot be obtained through ejaculation. These procedures extract sperm from either the epididymis (the coiled tube where sperm mature) or directly from the testicular tissue where sperm are produced.

The surgery becomes necessary in cases of azoospermia, a condition where no sperm are present in the ejaculate. This can result from blockages in the reproductive tract (obstructive azoospermia) or problems with sperm production (non-obstructive azoospermia). Men who have undergone vasectomy or have congenital absence of the vas deferens may require sperm retrieval for fertility treatment.

Modern sperm retrieval techniques have improved success rates for assisted reproduction. The retrieved sperm can be used immediately for ICSI or cryopreserved (frozen) for future use. These procedures have become an integral part of male infertility treatment in Singapore, offering solutions when natural conception is not possible.

Ideal Candidates

• Men with obstructive azoospermia from vasectomy, infection, or congenital blockages
• Patients with non-obstructive azoospermia from testicular failure or genetic conditions
• Men with ejaculatory dysfunction, including retrograde ejaculation or anejaculation
• Patients with spinal cord injuries preventing normal ejaculation
• Men with very low sperm counts where collection is difficult
• Couples preparing for IVF/ICSI cycles requiring surgical sperm retrieval
• Patients who have failed previous attempts at sperm collection through ejaculation

Contraindications

• Active genital tract infections requiring treatment before surgery
• Severe bleeding disorders without proper medical management
• Certain medications that increase surgical risks (temporary cessation may be required)
• Severe testicular atrophy where sperm production is absent
• Some genetic conditions incompatible with sperm production

A thorough evaluation by an MOH-accredited urologist is essential to determine the appropriate sperm retrieval method. This assessment includes hormone testing, genetic screening when indicated, and sometimes testicular ultrasound to evaluate the underlying cause of infertility and predict the likelihood of successful sperm retrieval.

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is a minimally invasive technique where a fine needle is inserted through the scrotal skin directly into the epididymis. This procedure is performed under local anaesthesia and typically takes 10-20 minutes. PESA works well for obstructive azoospermia where the epididymis contains mature sperm. The technique allows for multiple aspirations if needed and often yields sufficient sperm for several ICSI cycles.

Testicular Sperm Aspiration (TESA)

TESA involves inserting a needle directly into the testicular tissue to aspirate sperm. This technique is used when epididymal sperm retrieval is unsuccessful or when non-obstructive azoospermia is suspected. The procedure can be performed in multiple areas of the testis to increase the chances of finding sperm. TESA is performed under local anaesthesia and causes minimal tissue damage.

Testicular Sperm Extraction (TESE)

TESE is an open surgical procedure where a small incision is made in the scrotum to expose the testis. A small piece of testicular tissue is then removed and examined for sperm. This technique allows for direct visualisation of the testicular tissue and selective sampling from areas likely to contain sperm. Conventional TESE can be combined with microscopic examination for improved results.

Microsurgical Epididymal Sperm Aspiration (MESA)

MESA uses an operating microscope to identify and isolate epididymal tubules containing sperm. This precise technique often yields quality sperm in large quantities, suitable for both immediate use and cryopreservation. MESA is effective for obstructive azoospermia and provides good sperm quality for ICSI procedures.

Technology & Equipment Used

Modern sperm retrieval procedures utilise operating microscopes for precision, specialised aspiration needles and equipment, and sperm processing systems. Immediate microscopic evaluation ensures viable sperm are identified during the procedure. Cryopreservation technology allows excess sperm to be frozen for future use, reducing the need for repeated procedures.

Pre-Treatment Preparation

Before sperm retrieval surgery, patients undergo comprehensive fertility evaluation including hormone testing (FSH, LH, testosterone), genetic testing when indicated, and scrotal ultrasound examination. Patients should discontinue blood-thinning medications as advised and arrange for transportation home after the procedure. Some men may need to provide a semen sample for analysis if ejaculation is possible. The fertility clinic coordinates timing with the female partner’s IVF cycle when applicable.

During the Procedure

The surgical area is cleaned and draped in a sterile manner. Local anaesthesia is administered to numb the surgical site, though some procedures may use sedation or general anaesthesia. For needle aspiration techniques (PESA/TESA), the surgeon carefully inserts the needle and aspirates fluid or tissue. Open procedures (TESE/MESA) involve a small incision for direct access to the epididymis or testis.

An embryologist immediately examines the retrieved sample under a microscope to confirm the presence of viable sperm. Multiple samples may be taken to ensure adequate sperm for the planned fertility treatment. The entire procedure typically takes 20-60 minutes depending on the technique used.

Immediate Post-Treatment

After the procedure, patients rest in the recovery area with ice packs applied to reduce swelling. Pain medication is provided as needed, though most men experience only mild discomfort. The surgical site is checked for bleeding before discharge. Patients receive detailed aftercare instructions and emergency contact information. Most men can return home within 1-2 hours of the procedure.

First 24-48 Hours

Apply ice packs to the scrotal area for 20 minutes every hour while awake to minimise swelling. Take prescribed pain medication as directed, though many patients need only over-the-counter pain relief. Wear supportive underwear or a scrotal support to reduce discomfort. Avoid strenuous activities, heavy lifting, and sexual activity. Watch for signs of infection such as increasing pain, fever, or unusual discharge.

First Week

Continue wearing supportive underwear to promote comfort and healing. Gradually return to normal daily activities as tolerated, avoiding strenuous exercise. Keep the surgical site clean and dry, following specific wound care instructions. Attend follow-up appointments as scheduled to ensure proper healing. Most men can return to work within 2-3 days for desk jobs or 5-7 days for physical work.

Long-term Recovery

Complete healing typically occurs within 2-3 weeks. Sexual activity can usually resume after 1-2 weeks with surgeon approval. Follow-up semen analysis may be performed if natural conception is being attempted after obstruction reversal. Discuss results with the fertility team to plan next steps in treatment. Some patients may require additional procedures if initial retrieval was unsuccessful.

Sperm retrieval surgery enables biological fatherhood for men who cannot produce sperm in their ejaculate, offering hope where natural conception is impossible. The procedures have good success rates for finding viable sperm, particularly in cases of obstructive azoospermia where success rates exceed 90%. Retrieved sperm can be used immediately for ICSI or frozen for multiple future attempts, providing flexibility in family planning.

These minimally invasive techniques cause minimal discomfort and allow quick recovery, with most men returning to normal activities within days. The ability to retrieve sperm directly from the source bypasses blockages and other obstacles to fertility. For couples undergoing IVF, surgical sperm retrieval synchronises with the female partner’s cycle for optimal outcomes. The procedures provide diagnostic information about sperm production, helping guide future treatment decisions.

Common Side Effects

Mild pain and discomfort at the surgical site typically resolve within a few days with simple pain relief. Scrotal swelling and bruising are normal and improve with ice application and supportive underwear. Small amounts of blood in the urine may occur but usually clear within 24-48 hours. Temporary tenderness during movement or sitting is expected during the healing process.

Rare Complications

Infection at the surgical site occurs in less than 1% of cases and responds well to antibiotics when identified early. Significant bleeding or haematoma formation is uncommon but may require additional treatment. Very rarely, damage to surrounding structures or blood vessels may occur. Some patients may experience chronic pain, though this is uncommon with proper technique.

Our experienced urologist in Singapore uses meticulous surgical technique and sterile procedures to minimise all risks. Careful patient selection and pre-operative planning reduce the likelihood of complications.

The cost of sperm retrieval surgery varies depending on the specific technique used, with more complex procedures like MESA typically costing more than simple needle aspirations. Factors affecting price include the need for operating theatre time, type of anaesthesia required, and whether multiple retrieval attempts are necessary. The fee typically covers the surgical procedure, surgeon and anaesthetist fees, use of specialised equipment, and immediate sperm analysis.

Additional costs may include pre-operative testing, sperm freezing and storage if required, and integration with IVF/ICSI cycles. Our clinic provides transparent pricing during consultation, helping couples plan for their fertility journey. Choosing an experienced urologist familiar with various retrieval techniques optimises success rates and value.