TESA / PESA / MESA / TESE / Micro TESE

PESA (Percutaneous Epididymal Sperm Aspiration) and TESA (Testicular Sperm Aspiration) are methods used for surgical sperm aspiration. PESA is a method wherein sperm is collected from epididymis using a syringe and fine needle. TESA is a method wherein sperm is retrieved directly from the testicles. This is commonly used for men with azoospermia due to primary testicular disease (Very low sperm production in testis). In these men usually, there will be no sperm in the epididymis and testicular sperm retrieval is needed.

If these procedures fail to retrieve sperm, then testicular sperm extraction (TESE) or micro TESE, which are open testicular biopsies, are performed to retrieve sperm.

Indications

Azoospermia due to primary testicular disease
Obstruction to the genital tract due to infection or previous surgery
Congenital absence of the vas deferens, commonly seen in the patients with cystic fibrosis
Patients with vasectomy

Step 1

These surgical procedures can be performed under local anesthetic or sedation, depending on the preference of the patient and the clinician. The patient can go back to work within 4-5 days and usually advised to wear a scrotal support for 48 hours in order to protect the scrotum and testes. The patient may experience mild discomfort following the procedure.

Step 2

As the sperm retrieved with these procedures is limited, ICSI (Intra Cytoplasmic Sperm Injection) is the preferred method of fertilization of egg. If we get more sperm, then the extra sperm are cryopreserved or frozen for future use, such that we do not have to subject the man to further surgical procedure.