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Surgical Sperm Retrieval (PESA and TESA)

Introduction

Surgical sperm retrieval is a technique for collecting sperm from the epididymis or testis.

Percutaneous Epdidymal Sperm Aspiration (PESA)

This is a simple procedure whereby sperm is aspirated from epididymis with a small needle. There is no cut involved in this procedure. After collecting the sample, it is examined under the microscope to confirm the presence of sperm. If this is not successful in retrieving sperm TESA is performed.

 

Testicular Sperm Aspiration (TESA)

Here the sperm is directly obtained from the testis with a small needle and suction applied with a small syringe.

After the operation, there may be some discomfort and bruising for a few days. Pain killers such as Paracetamol or codeine tablets can be used to abate the discomfort. A firm scrotal support (tight underwear) is recommended for a few days after the procedure. This will prevent any bleeding and swelling of the scrotum.

 

Who will benefit from PESA/TESA?

Men with no sperm in the ejaculate (azoospermia) will benefit from this treatment. The two types of azoospermia are described below.

 

Obstructive

The sperm production in the testis is normal but there is a blockage in the tube (vas deferens) which carries the sperm from the testis. The blockage can be due to infection, congenital absence of vas deferens, previous vasectomy or failed vasectomy reversal. In such cases, there is a 70 to 80% chance of success.

 

Non-obstructive

Here there is no obstruction in the passage. Sperm production might take place in some pockets of testicular tissue only. In such cases, the chance of success is between 20 and 40%.

Types of PESA/TESA

Diagnostic

This is performed as a diagnostic procedure first before starting the treatment for the female partner. By this method, one can know whether or not it is possible to get sperm by this technique. If sperm is aspirated, it can be frozen for future use.

If it is not successful, one can think of other options, like using donor sperm. If donor sperm is not an option, one need not proceed with the treatment of the female partner.

 

Therapeutic

Here the procedure is performed on the day of egg collection of the female partner. If sperm is aspirated, the fresh sperm can be used for the treatment and the surplus frozen for use. If the procedure is not successful, one can use donor sperm for the treatment or the whole treatment (egg collection) has to be abandoned. The only negative aspect of this method is not knowing in advance about the success of retrieving the sperm. However, the positive side is that, if the procedure is successful, fresh sperm can be used for the treatment.

The disadvantage with the diagnostic PESA/TESA is that it may become necessary to repeat the procedure on the day of egg collection if the frozen sperm do not survive the thawing process.

Sperm that is retrieved by PESA/TESA is incapable of fertilization by conventional methods. Fertilization is achieved by ICSI i.e. by injecting a single sperm into an egg.

Advantages

This technique gives the couple an opportunity to have their own genetic baby even when there is no sperm in the ejaculate. Additionally, the procedure is very simple.

 

Disadvantage

The procedure may have to be repeated for fresh ICSI treatments (i.e. if a frozen sample from a previous PESA/TESA does not survive the thawing process).