(Microsurgical testicular sperm extraction and Percutaneous testicular sperm aspiration)

These procedures are carried out together with ICSI and when the male partner is diagnosed with azoospermia (absence of sperm in the ejaculate). It involves microsurgery of the testis by an experienced urologist or fertility specialist. During the surgery, a small fraction of the testicular tissue is removed under anaesthesia. From the testicular and/or epididymal tissues, the embryologist will extract the sperm cells from the tissues and are processed for ICSI.

Two causes for azoospermia are non-obstructive and obstructive. Non-obstructive azoospermic males have either Sertoli-cell-only syndrome or development arrest of the sperm cells. On the other hand, obstructive azoospermic males generally have reasonable sperm production capacity but the sperm could not be deposited in vagina due to obstruction in the tubes that transport sperm into the penis. Success rates for ICSI with non-obstructive azoospermia are generally lower than ICSI with obstructive azoospermia.