These sperm retrieval procedures are performed in men who are azoospermic, i.e., they do not have sperms in the semen. Sperms are directly removed from the testes and used for fertilizing the eggs by ICSI. PESA & TESA are performed in men with obstructive azoospermia. mTESE is performed in men who have no obstruction in the passage of sperms but are infertile due to extremely low sperm production.
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA or Percutaneous Epididymal Sperm Aspiration, does not require a surgical incision. A small needle is passed directly into the head of the epididymis through the scrotal skin and fluid is aspirated. The embryologist retrieves the sperm cells from the fluid and prepares them for ICSI & also cryopreserves any extra sperms available.
Testicular Sperm Aspiration (TESA)
TESA or testicular sperm aspiration is performed by inserting a needle in the testis and aspirating fluid and tissue with negative pressure. The aspirated tissue is then processed in the embryology laboratory and the sperm cells extracted are used for ICSI.
Microscopic testicular sperm extraction (Micro TESE)
This procedure is performed by making a small cut in the testicle and removing seminiferous tubules under magnification by looking through a surgical microscope. These tubules are then dissected under a microscope in the IVF lab to look for sperm. If found, the sperm can be used right away to fertilize an egg, or the sperm cells can be frozen, stored, and thawed at a later time to be used for infertility treatment.
In Whom Should These Procedures Be Performed?
PESA and TESA are performed in men with obstructive azoospermia (OA) which is in men who have normal sperm production in the testes, but some obstruction in the passage prevents them from reaching the outside world. mTESE is performed in men who have no obstruction in the passage of sperms but are infertile due to extremely low sperm production i.e., Non-obstructive azoospermia (NOA).
Before these procedures are performed, it must be confirmed that the female partner has the potential to produce enough eggs for IVF -ICSI and her uterus is normal. Also, a good assessment is to be done on the male partner to be reasonably sure that sperms will be obtained during these retrieval procedures.
Also, genetic diseases which may be associated with Azoospermia and may be passed on to the offspring must be ruled out. Once the risk is explained to the couple, they may choose to take this risk of having a baby with similar/ associated abnormalities or opt for donor sperm.
What Are The Chances Of Success?
The chances of successful sperm retrieval are more than 80% in men with obstructive azoospermia.
In men with non-obstructive azoospermia, the chances of successful sperm retrieval are in the range of 30 to 60%. Further on, the chances of successful pregnancy also depend on the age of the female partner, her ovarian reserve, and the health of the uterus.
How Are These Procedures Performed?
All procedures are performed by a qualified urologist who is well-versed with these procedures.
- PESA has done under local anesthesia.
- TESA has usually done under local anesthesia.
- mTESE is usually performed under spinal anesthesia.
What Are The Risks/ Complications?
Rare chances of infection or hematoma formation are there. Baseline anesthesia risk is there if it is given.