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Sperm collection + possible sampling from the testis (microsurgical)

What does this procedure entail?

Collection of sperm (male germ cells) from the epididymis or from the testicle for artificial insemination + eventual diagnostics of the disorder of their formation (biopsy)

What are the alternatives to this procedure?

Other forms of assisted reproduction

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.

At the request of the referring physician, you will have to schedule preoperative examinations to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery.

You will be asked to refrain from eating or drinking for at least 6 hours before the procedure. Immediately before the procedure, you will receive medication from an anaesthesiologist, which will calm you down – you can only feel dry in your mouth. Remember to inform your physician about the following possible facts before the surgery:

  • artificial heart valve
  • coronary artery stent
  • pacemaker
  • artificial joint
  • artificial vascular graft
  • neurosurgical bypass
  • other implanted foreign body
  • use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
  • drug and other allergies
  • any abnormalities or eventualities

It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

What will happen during the surgery?

You will usually be admitted to the hospital in the morning before the procedure (on an empty stomach – see above). The scrotum must be completely shaved before the procedure. The procedure is performed under general anaesthesia.

The procedure is performed from an incision on the scrotal side – under a microscope, fluid is sucked out of the epididymal ducts, which is immediately examined in the laboratory. If a sufficient amount of high-quality sperm cells is detected, the procedure is finished. If sperm cannot be obtained from the epididymis, a small sample of testicular tissue is taken – both to obtain gametes from this tissue and usually for histological examination to specify the cause of the sperm production/maturation disorder.

After the procedure, the wound is closed with absorbable sutures and usually without the use of a drain.

The surgery takes about 30-45 minutes.

What will happen immediately after the procedure?

You will wake up at the intensive care unit equipped for the continued monitoring of patients immediately after the procedure. The surgeon will inform you about the course of the procedure. You will still have high levels of anaesthetics in your blood at that time, so you may not remember this conversation.

As soon as your medical condition allows, you will be allowed to sit down and then stand up. After that, you will be able to walk slowly and carefully around the room, initially accompanied by medical staff. Pay close attention to eventual dizziness, uncontrollable weakness, and to gait stability. Otherwise immediately inform medical personnel or anyone in the vicinity.

Soft tissues of the scrotum may swell during the postoperative period. It gradually disappears within a few days to weeks, as does the discomfort or mild pain.

Once you are fully conscious, you should:

  • ask if the planned outcome was achieved
  • inform the medical staff about any problems
  • ask what you can and cannot do
  • ask all the questions you have for the healthcare professionals and members of the medical team.
  • remember (and understand) why the surgery was performed, how it turned out, and what will follow

The average length of hospitalisation is 1 to 2 days.

What are the postoperative risks or complications?

Common (10% of procedures of this type)

  • Haematoma in the subcutaneous tissue, swelling of the scrotum – may take several days

Occasional (2-10% of procedures of this type)

  • There is no guarantee that sperm cells will truly be collected
  • There is no guarantee of pregnancy

Rare (may occur in 2% of procedures of this type)

  • Deterioration of obstruction of vas deferens / ducts of the epididymis
  • Serous (wound) secretion up to a few days after the surgery
  • Infection or bleeding at the site of surgery requiring surgical revision

Hospital infections

  • MRSA colonisation (0.9% – 1 of 110)
  • Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
  • MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

  • Get recommendations on recovery at home
  • Ask when you can return to normal activities such as work, exercise, driving, housework
  • Get a contact number for further questions after returning home or in case of trouble
  • Ask about the date and place of subsequent check-ups (hospital or your doctor)
  • Make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs

At your departure from the hospital (sometimes several days later), you will receive a hospitalisation report. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

The wound should be clean and dry for a full 24 hours. If clothes stick to it, they can be removed after a short bath or shower. You should not bathe or shower until the area has healed, as this could lead to quick dissolution of the sutures and infection and poor healing. For the first few days, the scrotum and groin may be slightly numb and swollen.

It is recommended to wear tight underwear or a suspender until the swelling subsides or until any problems disappear.

You should stay at home for 10-14 days and avoid any strenuous exercises to enable the wound to heal. You should avoid sexual intercourse for about 14 days, or until all eventual problems improve.

What else should I watch out for?

If you experience more frequent problems, fever, redness, pulsation or discharge from the wound, see your attending physician.

Important information?

The first postoperative check-up will be performed at our outpatient department (your appointment will be scheduled before your discharge); further follow-up is usually performed at the assisted reproduction centre, where you will receive further information about the success of fertilisation.

 

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