The best treatment choice for the man with obstructive azoospermia (zero sperm count because of a block in the reproductive tract) is percutaneous epididymal sperm extraction (PESA) with ICSI (intracytoplasmic sperm injection) in which epididymal sperm are injected into the eggs in order to fertilise them. Here is a photo-essay which describes the painless technique we use in our clinic for extracting epdidiymal sperm in azoospermic men when they need PESA-ICSI (percutanesous epididymal sperm aspiration with intracytoplasmic sperm injection.)
In the US, most urologists still use an operating microscope to recover epididymal sperm. This is called MESA - micro-epididymal sperm aspiration, which is very expensive and very time consuming. It also involves anesthesia and cutting open the scrotum.
Most men are understandably scared of allowing a surgeon near their testes - and even a testis biopsy can be a very painful experience! This simple technique allows us to extract epdidiymal sperm, without even having to make a skin incision!
Not only is this much easier for the patient, it also much less traumatic, which means it can be repeated if needed. It is usually done under local anesthesia.
If you would like to see a closeup, please click on the thumbnail of the image of interest.