Percutaneous Epididymal Sperm Aspiration (PESA)
PESA is a simple technique to obtain sperm for Intracytoplasmic Sperm Injection (ICSI) in men who have an obstruction of the vas deferens, either due to vasectomy or other obstruction. The procedure involves a small needle that is inserted through the skin of the scrotum to collect sperm from the epididymis, where sperm are usually stored after production in the testes.
In 80% of attempts, sufficient sperm for ICSI is obtained while in 10% of cases enough suitable sperm is found for cryopreservation. The procedure is performed with local anesthesia and is coordinated with the female partner’s egg retrieval.
Advantages of PESA
The procedure is simple, quick, avoids open surgery and can be repeated. Our embryologists have had several cases in where they have repeated the procedure two to three times and obtained adequate sperm each time.
Testicular/Epididymal Sperm Aspiration or Extraction- TESE OR TESA
If sperm cannot be found in the epididymis, our embryologists then proceed to a Testicular Sperm Extraction (TESE). The procedure in TESE is almost similar. TESE is used for men with both obstructive and non-obstructive azoospermia. It is performed with local anesthesia in the operating room or office and is coordinated with their female partner’s egg retrieval. A needle is inserted in the testicle and tissue/sperm are aspirated. TESE is performed for men with obstructive azoospermia (s/p vasectomy). Occasionally, TESE doesn’t provide enough tissue/sperm and an open testis biopsy is needed.
During TESE, sperm is obtained by means of a biopsy of the testicle. The sperm obtained from these procedures is then injected directly into the eggs (ICSI). The simplest, least invasive procedure is tried first.
TESE is mainly used for men with extremely poor sperm production where very less sperm are produced that they cannot reach the ejaculate. TESE has helped for many couples in achieving pregnancy, but there is some concern with the use of this sperm because in most cases the underlying condition causing the poor sperm production is still unknown.
Advantages of TESE
This is a simple, non-surgical procedure that can be performed without special training or equipment.
At International Fertility Centre, TESE is performed by the embryologist team. Before anything, it is important to understand the root cause of the problem so doing a thorough analysis is also recommended.