Sperm extraction: Two percutaneous techniques

Marc Holden, MD

T. Mike Hsieh, MD

Commentary by Craig Niederberger, MD

This video describes and demonstrates two techniques for minimally invasive sperm retrieval appropriate for men with obstructive azoospermia. Procedure selection, benefits/limitations, and special equipment are discussed. A preferred technique of scrotal block and local anesthesia for scrotal procedures is also demonstrated.

Dr. Niederberger: Dr. Hsieh and colleague demonstrate minimally invasive surgical sperm extraction techniques for obstructive azoospermia, discussing the caveats and fine points, and all with a real hands-on approach. It's well worth watching for urologists called to extract sperm for use in intracytoplasmic sperm injection.

Dr. Hotaling: Here, Dr. Hsieh’s team demonstrates what many reproductive urologists feel is the gold standard (and embryology lab-preferred) technique for obtaining sperm from men who have obstructive azoospermia after a vasectomy. This procedure can be performed under local after a sufficient block is achieved with bupivicaine or lidocaine (we use 1% lidocaine without epinephrine). Typically a vasal sheath block along with a cord block and field block is performed and tested prior to beginning the procedure. Dr. Hsieh and colleagues use a Cameco syringe or a small butterfly to obtain sperm from the epididymis. They also demonstrate the correct technique for isolating the epididymis for this procedure, which can be challenging, especially in obese men. These techniques are preferred by the embryology lab, as they typically yield millions of highly concentrated sperm that can readily be used for in vitro fertilization (IVF) or cryopreserved for future use.  We prefer cryopreservation, as this allows the timing of the IVF cycle to be independent of the sperm extraction.