If several sperm examinations repeatedly reveal decreased sperm quality, an extended examination can be used to determine the cause.
Physical examination is made up of examining the following:
• Development during puberty (development of chest hair, pubic hair, penis and testicles)
• Size and shape of penis, testicles, epididymis
• Presence of sperm ducts
This examination is not painful.
In some cases, patients may be referred to a urologist for further examination, such as ultrasound examinations of the epididymis or the prostate.
If no spermatozoa have been found in the sperm, it may still be possible to retrieve sperm cells from the testicles or epididymis through a surgical procedure. A PESA (percutaneous epididymal sperm aspiration) is useful if the sperm ducts are blocked or not present. The treating physician will use a thin needle to take fluids from your epididymis. This is done using a local anesthetic. The fluids will then be examined for the presence of sperm cells.
A TESE (testicular sperm extraction) is useful if no spermatozoa have been found in the sperm and the sperm ducts are present and unblocked. The sperm cells will be retrieved directly from the testicle. During a TESE, the urologist will open the scrotum and testicle in order to remove a small tissue sample from the testicle. The analyst will then examine this biopsy for spermatozoa.
If sperm cells are found using a PESA or TESE, they can be cryogenically preserved to fertilize oocytes at a later date through ICSI.