PESA (percutaneous epididymal sperm aspiration) and TESA (Testicular Sperm Aspiration) are the two methods used for surgical sperm aspiration. Surgical sperm aspiration is a treatment that is recommended for men with azoospermia. Azoospermia is the condition of the complete absence of any sperm in a man’s semen. Men with azoospermia can father a child through intra-cytoplasmic sperm injection if sperm can be recovered from their epididymis or testis.
They are simply invasive techniques and sperm can be obtained from men with a variety of concerns including vasectomy, failed vasectomy reversal, an absence of the vas deferens, blockages somewhere along the seminal tract (obstructive azoospermia) or any problem arising from injury or infection. Sperm retrieval is also able to help men with a very low sperm count (non-obstructive azoospermia) become fathers.
These methods can be considered when a male partner is suffering from any one of the following conditions:
- Primary testicular problems with deficient sperm production
- An irreversible obstruction in the genital tract caused due by an infection or previous surgery
- Congenital absence of the vas deferens commonly seen in the carriers of cystic fibrosis
- Has undergone a vasectomy or an unsuccessful vasectomy reversal
Several percutaneous and open surgical procedures have been described to retrieve sperm. In men with obstructive azoospermia, epididymal sperm can usually be retrieved by percutaneous epididymal sperm aspiration (PESA).
PESA is a method in wherein sperm is collected from epididymis inside the scrotum using a syringe and fine needle. The sperm is then implanted into the egg through the process of ICSI (Intracytoplasmic Sperm Injection). This method is often used when there is no sperm found in the ejaculate due to hindrance in the passages.
TESA is a method wherein sperm is retrieved directly from the testicles. This is commonly used for men with non-obstructive azoospermia (very low sperm in testes who have problem with sperm production). In these men usually, there will be no sperm in the epididymis and testicular sperm rescue is required. Testicular sperm are obtained by TESA or needle aspiration biopsy (NAB).
Percutaneous retrieval by NAB can be tried first. If that fails then testicular sperm extraction (TESE) from open microsurgical biopsies is performed using the single seminiferous tubule (SST) or the micro dissection.
Both of these surgical procedures can be performed under local anesthetic or sedation, depending on the preference of the patient and the clinician.
ICSI treatment using sperm obtained by PESA or TESA is a commonly performed procedure and has good success rates. In general,the success rate is around 30-35% for every treatment cycle.
To obtain good success rates in this group of patients, our embryologists at KIMS fertility centre, use advanced additional techniques such as IMSI (Intracytoplasmic Morphologically selected Sperm Injection) to select better sperm. Other advanced techniques such as calcium to activate the egg and sperm activation agents are also used to improve the outcome of ICSI in this group of patients and our embryologists have been trained in all the latest techniques to optimise the outcome for our patients.
- The patient can go back to work within 4-5 days. It is usually advised to wear a scrotal support for 48 hours in order to protect the scrotum and testes.
- The stitches need not be removed as they will dissolve automatically within 14 days.
- The patient may experience mild discomfort that includes pain, tenderness, infection and cloudy discharge.