Sperm harvesting is entirely different from a diagnostic testicular biopsy because, in this setting, 目的不是确定睾丸中发生了什么，而是寻找精子. Only men with no sperm in their ejaculate (azoospermia) need to have sperm retrieved directly from the testis or epididymis.

这可能包括对有阻塞的男性进行简单的抽吸，或者对有精子产生问题的男性需要进行更广泛的睾丸取样. As a result, there is a significant difference in the amount of time it takes, the need for anesthesia and the equipment utilized.

很少有测试能准确预测睾丸有问题的男性是否能在睾丸中找到精子. Genetic testing may give insight into the chance of finding sperm but are not absolute. 在诊断性睾丸活组织检查时发现的睾丸问题的模式可能具有轻微的预测性, but again there is no finding that absolutely predicts the presence or absence of sperm. Other blood tests, including hormonal studies, are not predictive.

Finally, 即使在之前的采集过程中发现了精子，也不能保证在未来的采集过程中也能找到精子. Thus, 诊断性睾丸活组织检查不常规进行患者的睾丸采集精子时，他们的精子数量为零的原因已经通过其他手段确定.

The Timing of Sperm Retrieval

精子采集的时间与体外受精(IVF)周期相结合是一个难以解决的问题. 在体外受精周期之前或与女性伴侣的卵子一起进行精子采集有好处也有坏处. The ultimate decision is made by the preference of the IVF program. 提前采集精子，冷冻精子，直到卵子被采集，这样夫妇就可以在知情的情况下决定是否进行体外受精, since in most circumstances the chance of finding sperm may be only 60 percent or less.

Moreover, 许多夫妇很难在同一天接受手术，因为这需要他们争取其他资源来帮助他们往返医院并在家中提供帮助. 试管婴儿实验室通常更喜欢使用新鲜精子而不是冷冻精子，因此他们对新鲜精子的渴望胜过其他任何考虑.

As a result, simple sperm retrievals are typically performed the day of egg retrieval. 简单的精子提取是对已知有梗阻的男性进行的手术，他们可以毫无问题地制造精子. These procedures are summarized below, and include testicular sperm aspiration (TESA), percutaneous sperm aspiration (PESA) and testicular sperm extraction (TESE).

Microdissection TESE (MicroTESE) is a much more involved procedure and is performed the day before the female partner’s egg retrieval. MicroTESE与生殖内分泌学家密切协调，并在指定时间进行，每季度一次.

Which sperm retrieval procedure is recommended?

有很多方法可以从精子生产正常但有阻塞的男性身上获取精子. The simplest and most cost-effective is an aspiration of sperm. This is routinely performed under local anesthesia and takes approximately 10 minutes.

从睾丸有问题的男性身上采集精子要困难得多，通常需要几个小时. The ideal procedure, microTESE, 是在外科显微镜的帮助下进行的，这样发现精子的机会增加了，从睾丸中取出的组织的数量可以最小化.

重要的是要明白，手术室里使用的显微镜没有足够的放大倍数来看到精子，而只是帮助区分睾丸内哪些小管更可能含有精子. 在试管婴儿过程中，少量的组织被送到试管婴儿实验室，这样他们就可以评估是否已经获得了足够数量的精子. A more powerful microscope is used by the IVF laboratory to evaluate this tissue. 从一个或两个睾丸中反复进行活组织检查，直到获得足够的精子用于试管受精周期. 额外的精子可能会被收集起来，以备未来的试管受精周期，以防当前周期失败或夫妇将来想要更多的孩子. This procedure can take as long as four hours depending upon how quickly sperm are found.

Here is a summary of the procedures available for sperm harvesting:

Testicular sperm aspiration (TESA)

TESA is a procedure performed for men who are having sperm retrieved for IVF/ICSI. 在手术室或办公室进行局部麻醉，并配合女性伴侣取卵. A needle is inserted in the testicle and tissue/sperm are aspirated. TESA is performed for men with obstructive azoospermia (s/p vasectomy). 偶尔，TESA不能提供足够的组织/精子，需要进行开放的睾丸活检.

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA是针对因输精管切除术或感染而患有阻塞性无精子症的男性进行试管受精/ICSI取精的手术. 在手术室或办公室进行局部麻醉，并配合女性伴侣取卵.

Testicular sperm extraction (TESE)

TESE包括在睾丸上做一个小切口，检查小管是否存在精子. 这要么是一个预定的程序，要么是与他们的女性伴侣的取卵相协调. TESE is usually performed in the operating room with sedation, but can be performed in the office with local anesthesia alone. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. MicroTESE已经取代了这种方法，成为精液中没有精子(无精子症)的男性从生产问题中提取精子的最佳形式.

Microepididymal Sperm Aspiration (MESA)

MESA是输精管或附睾梗阻(输精管切除术)患者的手术, congenital bilateral absence of the vas deferens). 这要么是一个预定的程序，要么是与他们的女性伴侣的取卵相协调. MESA在手术室全麻下利用手术显微镜进行. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI. 与抽吸技术相比，MESA允许广泛收集成熟精子, 对于先天性双侧输精管缺失的男性，它是首选的手术方法，因为它不会影响睾丸的类固醇生成.

Microdissection TESE (microTESE)

MicroTESE是为有精子产生问题和无精子症的男性进行的手术. MicroTESE是在手术室全身麻醉下在手术显微镜下进行的. MicroTESE is carefully coordinated with the female partner’s egg retrieval, and is performed the day before egg retrieval. This allows for each partner to be there for the other’s procedure. 患者经常有供体精子备用，以防在男性伴侣体内找不到精子. MicroTESE has significantly improved sperm retrieval rates in azoospermic men, and is a safer procedure since less testicular tissue is removed. Patients cryopreserve sperm during this procedure for future IVF/ICSI.