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A semen analysis showing no sperm is not the end of the conversation. In a significant proportion of men, sperm is being produced but is not reaching the ejaculate — and in that case it can be retrieved directly.
Testicular sperm aspiration. A fine needle draws tissue from the testis under local anaesthetic. It is quick, minimally invasive, and effective in obstructive azoospermia — where production is normal but the pathway out is blocked, whether by vasectomy, infection or congenital absence of the vas deferens.
Microdissection testicular sperm extraction, performed under an operating microscope so the surgeon can identify and sample the individual tubules most likely to contain sperm. It is the procedure for non-obstructive azoospermia, where production itself is impaired. It is more involved than TESA and takes longer, but it finds sperm in cases where a blind biopsy would not.
Retrieval is normally scheduled for the same day as the egg collection so the sperm is used fresh. Where the diagnosis is already established, it can be done in advance and the sample frozen — which spares you the risk of collecting eggs on the day and finding nothing to fertilise them with.
Worth knowing
Where retrieval finds no sperm, the honest next step is donor sperm rather than a repeat attempt. A prior hormone profile and genetic screen usually indicate in advance how likely retrieval is to succeed, and I will tell you what those results suggest before you commit to the procedure.
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