For men whose semen contains no sperm, the natural assumption is that biological fatherhood is off the table. Often, it isn’t. Microsurgical sperm retrieval makes it possible to recover sperm directly from the testicle or epididymis — even in many men with azoospermia — so those sperm can be used with IVF or ICSI to pursue a pregnancy. The difference between success and disappointment frequently comes down to surgical technique and experience.
Dr. Justin Houman is a board-certified urologist, Fellow of the American College of Surgeons, and fellowship-trained microsurgeon in Male Reproductive Medicine and Surgery, training he completed at UCLA Medical Center. As an Assistant Professor of Urology at Cedars-Sinai Medical Center in Los Angeles, he performs the microdissection techniques that make sperm retrieval most successful — methods that demand both specialized training and a high volume of complex cases.
I had an excellent experience with Dr. Justin Houman, who is truly an expert in male fertility. He took the time to listen carefully and explain all the available options in a way that was easy to understand. His approach is compassionate, professional, and very thorough. I felt confident knowing I was in the care of someone highly specialized in men’s reproductive health. If you are looking for a knowledgeable and caring physician to help with male fertility concerns, I highly recommend Dr. Houman.
What Is Microsurgical Sperm Retrieval?
Microsurgical sperm retrieval is a group of advanced procedures used to obtain sperm directly from the male reproductive tract when none are present in the ejaculate. The retrieved sperm can be used immediately with intracytoplasmic sperm injection (ICSI) during in vitro fertilization, or frozen for later use. The right technique depends on the cause and the individual:
- MicroTESE (Microdissection TESE): Uses an operating microscope to locate and extract sperm from the areas of the testicle most likely to contain them.
- TESE (Testicular Sperm Extraction): Removes a small amount of testicular tissue to retrieve sperm.
- TESA (Testicular Sperm Aspiration): Withdraws sperm from the testicle through a fine needle.
- MESA (Microsurgical Epididymal Sperm Aspiration): Collects sperm from the epididymis using microsurgical technique.
- PESA (Percutaneous Epididymal Sperm Aspiration): Retrieves sperm from the epididymis through the skin with a needle.
Is Microsurgical Sperm Retrieval Right for You?
Sperm retrieval is considered when sperm are absent from the ejaculate but may still exist within the reproductive tract. Dr. Houman commonly evaluates the procedure for:
- Men with obstructive or nonobstructive azoospermia
- Men with anejaculation or retrograde ejaculation
- Men who have had a vasectomy and are not ideal candidates for vasectomy reversal
- Men preserving fertility ahead of certain medical treatments
What to Expect From the Procedure
Microsurgical sperm retrieval is performed in an operating room, typically under general anesthesia. Using a high-powered microscope, Dr. Houman opens the outer tissue of the testicle and carefully identifies the regions most likely to contain viable sperm before closing the area with fine sutures. Depending on how readily sperm are located, the procedure can take anywhere from under an hour to a few hours. Recovery is usually straightforward: most men rest for a few days, use ice and prescribed medication to manage swelling and discomfort, and return to desk work within 24 to 48 hours. Those with physically demanding jobs should plan for five to ten days of limited activity.
Frequently Asked Questions About Microsurgical Sperm Retrieval
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Microdissection testicular sperm extraction uses an operating microscope to identify and remove sperm from the small pockets of the testicle most likely to contain them, improving the chance of finding viable sperm while minimizing tissue damage.
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Men with obstructive or nonobstructive azoospermia, anejaculation, retrograde ejaculation, or a vasectomy with low reversal odds may be candidates, and a full evaluation confirms the best approach.
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Yes — sperm recovered during the procedure can be used immediately with ICSI during IVF, or cryopreserved for future use.
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It is performed under anesthesia, so there is no pain during surgery; afterward, most men experience manageable soreness controlled with ice, rest, and prescribed medication.
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Many men return to desk work within 24 to 48 hours, while those with physically demanding jobs should plan for five to ten days of limited activity.
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Even with the best technique, retrieval is not always successful; Dr. Houman discusses this possibility honestly beforehand and reviews remaining options, such as donor sperm, when needed. Learn more about azoospermia.
Why Patients Choose Dr. Houman for Sperm Retrieval
- Microdissection Expertise: Fellowship training in microsurgery supports the precise microTESE technique associated with higher retrieval rates.
- Tissue-Preserving Approach: The operating microscope helps locate sperm while protecting healthy testicular tissue and hormone function.
- Coordinated IVF Timing: Dr. Houman synchronizes retrieval with the partner’s IVF cycle so fresh sperm are ready when needed.
- Honest Candidacy Assessment: Each man receives a realistic picture of his likelihood of success before moving forward.
Meet Dr. Houman
Expert in Men’s Health with Tower Urology and Cedars Sinai
Dr. Justin Houman, MD, FACS is a board-certified urologist and fellowship-trained microsurgeon at Tower Urology, Cedars-Sinai Medical Center in Los Angeles. His subspecialty training in male reproductive medicine and microsurgery is held by fewer than 2% of practicing urologists in the United States.
His clinical focus is narrow by design. Varicoceles, chronic testicular pain, male infertility, vasectomy, testosterone optimization, erectile dysfunction, penile implant surgery, and Peyronie’s disease are not add-on services here. They are the practice. Patients travel from across the country and internationally for procedures, particularly microsurgical varicocelectomy, spermatic cord denervation, and inflatable penile implant surgery, that require a level of subspecialty training and surgical volume most urology practices do not have.
Schedule a Sperm Retrieval Consultation in Los Angeles
When no sperm appear in the ejaculate, the right surgical approach can still open a path to biological fatherhood — and knowing your odds starts with an expert evaluation. Dr. Houman offers advanced microsurgical retrieval and honest, coordinated fertility care for patients across Los Angeles and Southern California. Contact the Los Angeles office to schedule a consultation and learn whether sperm retrieval is the right step for you and your partner.
