Sperm retrieval – PESA & TESA

Under normal conditions, the sperms are produced in the testis, stored in the epididymis and travel through the vas deferens to reach the ejaculatory duct. At ejaculatory duct, the semen released by the seminal vesicles takes the sperms to be ejected from the tip of the penis during ejaculation.

This may not be possible with obstructions preventing sperm release that may be caused by injury or infection or the congenital absence of the vas deferens.

Non-obstructive azoospermia is a condition in which the testicles are producing such low numbers of sperm that they don’t reach the vas. Retrograde ejaculation is the condition in which semen enters the bladder instead of emerging through the penis during orgasm.
These conditions can be rectified by simple sperm retrieval during the pathway of sperm ejaculation.

In cases of non-obstructive azoospermia (complete absence of sperm) very small amounts of sperm may be produced and can be collected directly from the testes with a testicular biopsy. This will be sent to the laboratory for analysis as to the possible cause of the problem.

In men with obstructive azoospermia there is a very high chance of recovering sperm by this method (>90%). In men with non-obstructive azoospermia the chances of recovering sperm is approximately 40%. If sperm can be retrieved, the pregnancy rate for this treatment is very similar to that of ICSI with ejaculated sperm.

Techniques

PESA (Percutaneous epididymal sperm aspiration)

is the collection of sperm through a fine needle directly from the epididymis, where sperm is stored, after it is formed in the testes.

TESE (Testicular sperm extraction)

is the collection of sperm from a biopsy or several biopsies from the testicular tissue after making a small incision in the scrotal skin.

Microsurgical epididymal sperm aspiration (MESA):

It is a variation of PESA in which the individual epididymal tubes are isolated by incising the scrotal skin, the tissue is observed under the microscope, and the epididymal fluid is aspirated from areas having maximum sperm density.

These are carried out as a day care procedure requiring only a few hours stay in hospital. It is carried out under local anaesthetic that may be combined with a light general anaesthetic.

Once the specimen is obtained, it is checked to make sure that sperms are present. The material collected with sperm will be frozen and place in storage for use at a later stage. These specimens are then thawed and used to inject the eggs obtained during IVF treatment using the technique of ICSI. If surgical retrieval of sperm is successful, usually enough sperm is obtained for several cycles of treatment (if required).

After procedure precautions

You can get back to work within 4-5 days. It is advised to wear scrotal support for 48 hours to protect the scrotum and testes. The stitches need not be removed; they will dissolve within 14 days.

You may experience mild discomfort which includes pain, tenderness, infection, and cloudy discharge.

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