Percutaneous epididymal sperm aspiration
(PESA) and testicular sperm aspiration (TESA) are
procedures for overcoming extreme male infertility.
Very low or zero sperm counts, and sperm that are
largely dead or completely immotile, can be treated
by these methods. The sperm are obtained directly
from the testis or the tiny ducts leading from the
testis before they risk damage from oxidation or are
exposed to antisperm antibodies in the epididymis
or the vas deferens. For azoospermia (complete absence
of sperm) caused by the general failure to develop,
TESA is able to make sure of microscopically small
fields of sperm production that can often be located.
The sperm which is collected can be used for intracytoplasmic
sperm injection (ICSI).
How is it done ?
The epididymis is aspirated to find
motile sperm cells. Generally this operation is reserved
for instances where obstruction has occurred. The
procedure is often combined with testis biopsy for
This procedure can be used for instances
where sperm production is a problem (non-obstructive
azoospermia) or where there is an obstruction to sperm
flow (obstructive azoospermia). Obstructive azoospermia
can be due to congenital absence of the vas deferens
or after a vasectomy operation.
Both TESA and PESA are relatively
quick procedures carried out at Centre. PESA surgery
can be performed under local anaesthesia or a short
general anaesthetic (the choice is yours). Sperm removed
are either utilized in the next few days for ICSI
or they are frozen for later use.
TESA for non-obstructive azoospermia
(low sperm production or maturation arrest) is a more
extensive operation. It can take over an hour, both
testicles are usually operated on, and multiple biopsies
are taken. A general anaesthetic is required. In quite
a few of these cases, we have successfully aspirated
sperm simply by fine needle aspiration under local
anesthesia or without any cut or stitches.
Please note again that if your partner
has her egg pick-up on the same day, you will need
someone to take you both home that day.
Father to Son?
It is possible that male children
of men with severe oligospermia or azoospermia will
inherit the same condition. We can test for some abnormalities
of the chromosomes that could be passed on to your
children. If you azoospermia is due to congenital
blockage of the epididymis or absence of the vas deferens,
you could have one or more genes associated with cystic
fibrosis, a serious lung disease. We can test you
and your partner for some of the more common genes
that cause cystic fibrosis. The centre offers advice
and counseling about possible genetic causes of male