Surgical Sperm Retrieval (SSR) is a group of specialist procedures used to collect sperm directly from the male reproductive tract for use in fertility treatment such as IVF with ICSI.
At Child Fertility, SSR is performed when sperm is not present in the ejaculate or cannot be obtained from a semen sample. Our Oxford-trained fertility and urology specialists use evidence-based techniques to retrieve sperm safely, with clear guidance and compassionate care at every step.
For couples in Saudi Arabia, SSR is often a key part of treatment for male factor infertility and can offer the possibility of biological parenthood even when sperm is not present in semen samples.
What is Surgical Sperm Retrieval?
SSR involves collecting sperm directly from either the epididymis or the testicle. The method used depends on the underlying cause of infertility and where sperm production or transport is affected.
Some men produce sperm normally but have a blockage preventing it from appearing in the ejaculate. Others have reduced or absent sperm production within the testicles. SSR techniques are tailored to these different conditions.
Before recommending SSR, your specialist will carry out a detailed assessment, which may include:
- Semen analysis
- Medical history and examination
- Hormone testing
- Ultrasound imaging where appropriate
- Genetic testing in selected cases
These investigations help determine the cause of infertility and identify the most appropriate treatment approach.
When is SSR needed?
SSR may be considered when:
- There is no sperm found in semen analysis (azoospermia)
- A blockage is preventing sperm from being released (obstructive azoospermia)
- Sperm production is reduced or absent in the testicles (non-obstructive azoospermia)
- Previous vasectomy or reproductive tract surgery has affected fertility
- IVF with ICSI is required because sperm cannot be obtained from the ejaculate
- Sperm freezing is planned following successful sperm retrieval
Your specialist will confirm whether SSR is appropriate based on your diagnosis and overall fertility plan.
Understanding Azoospermia
Azoospermia means there is no sperm present in the semen. This affects approximately 1% of men and around 10–15% of men seeking fertility treatment.
There are two main types of azoospermia, and understanding which type is present is important because it affects both treatment options and the likelihood of successfully retrieving sperm.
Obstructive azoospermia
In obstructive azoospermia, sperm production within the testicles is usually normal, but a blockage prevents sperm from reaching the semen.
This may occur because of:
- Previous vasectomy
- Congenital absence of the vas deferens
- Infection or inflammation
- Previous surgery affecting the reproductive tract
In these cases, sperm can often be retrieved successfully because production remains normal. Retrieval rates are generally very high and may approach 100% in some clinical settings, although success cannot be guaranteed.
Non-obstructive azoospermia
In non-obstructive azoospermia, sperm production within the testicles is reduced or impaired.
Possible causes include:
- Genetic conditions
- Hormonal disorders
- Previous cancer treatment
- Undescended testicles
- Unexplained testicular dysfunction
In these cases, sperm retrieval is more challenging because sperm production may be limited. However, many men still have small areas of active sperm production within the testicle that can sometimes be identified through specialist retrieval techniques.
SSR techniques
Surgical Sperm Retrieval (SSR) is an umbrella term that includes several sperm retrieval techniques. The most appropriate procedure depends on the cause of infertility, sperm production, and whether a blockage is present.
TESE
TESE (Testicular Sperm Extraction) involves removing a small sample of testicular tissue to search for sperm. It is commonly used in men with reduced sperm production or azoospermia.
Micro-TESE
Micro-TESE is a more advanced microsurgical version of TESE performed using high-powered magnification. This allows the surgeon to identify tiny areas within the testicle that may still be producing sperm, while minimising tissue damage.
Micro-TESE is often recommended for men with non-obstructive azoospermia and may offer higher sperm retrieval rates compared to standard TESE in complex cases.
Your specialist will recommend the most suitable procedure based on your diagnosis and fertility goals.
SSR procedure: What to expect
SSR is usually performed as a day procedure.
- You will meet your specialist and anaesthetist before the procedure
- The procedure is performed under local, spinal, or general anaesthesia depending on the technique used
- If only needle aspiration is required, this is usually performed under local anaesthetic, sometimes with mild sedation
- Before the procedure, you will need virology blood tests (for HIV, Hepatitis B, and Hepatitis C) so that any retrieved sperm can be safely frozen. These must be taken within three months of your procedure
- A fine needle or small incision is used to retrieve sperm from the epididymis or testicle
- Any retrieved sperm is immediately assessed in the laboratory
- If suitable, sperm may be used fresh or frozen for future IVF/ICSI treatment
Recovery after SSR
Most patients recover quickly and return home the same day.
You may experience:
- Mild swelling or bruising in the scrotal area
- Discomfort for a few days, usually manageable with simple pain relief
- Temporary sensitivity at the procedure site
Recovery advice includes:
- Wearing supportive underwear
- Taking simple painkillers such as paracetamol or ibuprofen to manage discomfort in the first few days
- Taking 5–7 days off work, or longer if your job involves physical activity
- Avoiding heavy lifting or strenuous exercise for the first few weeks
- Avoiding sexual activity until comfortable
- Using ice packs (wrapped) to reduce swelling if needed
What happens to retrieved sperm?
If sperm is successfully retrieved:
- It is used immediately for IVF with ICSI, or
- Frozen and stored for future treatment cycles
ICSI is typically required because retrieved sperm are often available in very small numbers and need to be injected directly into an egg.
SSR success rates
SSR success rates vary depending on the underlying cause of infertility and the type of procedure performed.
In men with obstructive azoospermia, where sperm production is normal but blocked from entering the semen, sperm retrieval success rates are typically very high and are often successful when sperm production is normal.
For men with non-obstructive azoospermia, where sperm production is reduced or impaired, success rates are lower and depend on the presence of active sperm production within the testicular tissue. Micro-TESE may improve retrieval outcomes in certain complex cases.
It is important to understand that successful sperm retrieval does not always guarantee pregnancy. IVF success also depends on:
- Egg quality
- Female fertility factors
- Embryo development
- Overall reproductive health
Your fertility specialist will discuss your individual likelihood of sperm retrieval and treatment success based on your test results and diagnosis.
Can men with azoospermia have biological children?
Yes — many men with azoospermia are still able to have biological children with the help of fertility treatment and surgical sperm retrieval techniques.
Azoospermia means there is no sperm present in the semen, but this does not always mean sperm production has stopped completely. In some cases, sperm is still being produced within the testicles but is unable to reach the ejaculate due to a blockage. In other cases, sperm production may be reduced but not entirely absent.
Procedures such as PESA, TESE, and Micro-TESE can sometimes retrieve viable sperm directly from the epididymis or testicle for use in IVF with ICSI.
The likelihood of success depends on:
- Whether the azoospermia is obstructive or non-obstructive
- Overall testicular function
- Hormone levels and genetic factors
- The presence of healthy sperm within the testicular tissue
Your fertility specialist will perform detailed investigations to determine the most appropriate treatment approach and your chances of successful sperm retrieval.
SSR and your fertility journey
SSR is often one part of a broader fertility plan. It is not suitable for every patient, and success depends on the underlying cause of infertility, overall reproductive health, and the female partner’s fertility factors.
At Child Fertility, our team carefully coordinates SSR with IVF and ICSI to support the best possible chance of successful fertilisation and pregnancy.
Moving forward with clarity
If you have been diagnosed with azoospermia or are exploring options for male fertility treatment in KSA, SSR may provide a pathway to biological parenthood.
Our specialists will guide you through every step with clear explanations, honest expectations, and personalised care.
When you feel ready, we can arrange a confidential consultation to review your results and discuss the most appropriate next steps.
FAQs
SSR is performed under local, IV, spinal, or general anaesthesia, so you will not feel pain during the procedure. Some mild discomfort or soreness afterwards is common, but this usually settles within a few days with simple pain relief.
Success depends on the underlying cause of infertility and the type of SSR used. In cases of obstructive azoospermia, the chance of retrieving sperm is close to 100%. In non-obstructive cases, success varies and your specialist will discuss your individual likelihood based on diagnostic results.
In some cases, it may not be possible to retrieve sperm. If this happens, your specialist will discuss alternative options with you, such as exploring further investigations where appropriate.
Most men recover within a few days and return to normal daily activities. We generally recommend 5–7 days off work (or more if your role is physically demanding), and avoiding heavy lifting or strenuous exercise for the first few weeks.
Yes. If sperm is retrieved successfully, it can often be used immediately for IVF with ICSI or frozen for use in a future cycle. Your fertility team will guide you on the best option based on timing and treatment planning.
We strongly recommend stopping smoking before fertility treatment wherever possible. Smoking is associated with reduced fertility in both men and women and may affect treatment outcomes. In men, smoking can negatively impact sperm quality and may contribute to some forms of male-factor infertility. Smoking can also increase the risk of complications following surgical procedures and may affect recovery. If you smoke, your specialist can discuss the support available to help you stop before treatment begins. Even stopping a short time before treatment may have positive health benefits for you and your future family.
SSR is generally a safe and well-established procedure when performed by experienced specialists. However, as with any surgical intervention, there are some risks to consider. These may include temporary swelling or bruising, mild discomfort, infection, and bleeding. Less commonly, some men experience chronic testicular pain, testicular atrophy (shrinkage) which may require hormone replacement therapy, or worsening obstruction of the vas deferens or epididymis. There is also a possibility that sperm may not be successfully retrieved. Your specialist will explain your individual risk profile in detail before the procedure and answer any questions you may have.
