What is TESA/TESE? Testicular sperm aspiration or extraction
Male factor infertility can affect 30-40% of all infertile couples. Numerous alternatives for treatment exist including medical and surgical therapy. Some men do not have sperm in their ejaculate but they can have sperm in their testes. TESE/TESA is a procedure to see if the testis contains sperm. These sperm cannot be directly placed into the female partner’s uterus, they must be directly injected into a human egg. The procedure of directly injecting a single sperm into the egg is called ICSI (intracytoplasmic sperm injection).
Who will need TESA/TESE?
- Men who do not have sperm in the ejaculate i.e. azoospermic sperm
- Men who have a blocked or absent Vas Deferens (e.g. Cystic Fibrosis sufferers)
- Men who have had a vasectomy, or a failed vasectomy reversal
Preparation for the procedure:
- Shave the testicles the night before
- Do not eat or drink for 4 hrs prior to the procedure.
- You will be unable to drive yourself home.
- Post operatively there may be swelling and discomfort, so you may require a few days off work. The procedure itself:
- You will have a drip inserted in your arm for giving medications, including sedative, an antibiotic and a pain killer
- You will be given a local anaesthetic prior to the procedure. A small incision is made on the testis to extract a small piece of testicular tissue. The incision is closed by sutures.
- You are advised to wear supportive underwear following the procedure for 24 hrs. · The sutures will dissolve over 2-4 weeks and can be itchy for 1-2 weeks. · Simple analgesics like panadol should be taken regularly for 48 hrs after the procedure. · Sometimes you can have a small amount of blood loss from the operation site, which settles down by applying pressure over the area for a few minutes. · Bruising is common. · Avoid any strenuous activity for the next 2 weeks. Complications related to the procedure: No serious adverse effects have been reported following TESA/TESE, suggesting that this is a safe procedure. Please contact Fertility PLUS if you have any concerns. If have any problems outside of clinic hours will need to seek medical attention from an out of hours medical clinic.
There are 2 options for doing a TESA – diagnostic; or therapeutic. In a diagnostic TESE, the surgeon performs multiple diagnostic biopsies to determine if sperm are being produced in the testes or not. If no sperm are found , the diagnosis of complete testicular failure is confirmed; and treatment options then include adoption or donor insemination, since there is no treatment at present for this condition. If sperm are found, then these testicular sperm can be cryopreserved; and used for ICSI treatment in the future.
The advantage of doing a diagnostic TESE is that it is less expensive; and there is no need to give the wife expensive injections for superovulation.
Unfortunately, the results with testicular sperm cryopreservation are poor in most labs; which means most men will need a repeat TESE if they want to use their sperm for ICSI. This involves a second TESE, after a gap of about 6 months. There is also a 20% risk that no sperm may be found in the second biopsy, since the first biopsy may have removed all the areas of sperm production.
PESA (percutaneous epididymal sperm aspiration)
To understand how PESA (percutaneous epididymal sperm aspiration) works, you have to first understand the anatomy of the male testicle
The testicle is connected to a tube called the epididymis. The epididymis is then connected to the vas deferens, a duct which transports sperm to the ejaculatory ducts and the urethra.In the event of a blockage in the vas deferens, sperm is unable to be transported into the urethra, making normal conception impossible. PESA is a special minimally invasive technique that extracts the sperm from the epididymis for use in assisted reproductive technology.
Who is PESA used for?
PESA is used as part of assisted reproductive treatments for infertility. It can be used for IVF, where the extracted sperm is mixed with the wife’s egg for fertilisation to occur, or it can be used for ICSI, where a single extracted sperm is injected directly into an egg to fertillise it.This procedure is commonly used for patients who have undergone a vasectomy. If they do not wish to undergo a vasectomy reversal, or if they have had a failed reversal, PESA is a good way to help them reproduce. A vasectomy is often completed through either the cutting of the vas deferens or creating a blockage in the vas deferens. This does not affect the epididymis, and it is possible to extract healthy sperm for artificial insemination.It is also possible to develop blockages in the vas deferens due to genetic conditions or infections to the vas deferens. In these situations, PESA can also be used to treat male infertility caused by the blockages.
During PESA, a very thin needle is inserted into the epididymis in order to extract the sperm. This procedure can be conducted in the clinic and does not require hospitalisation. The extracted sperm is then used as part of IVF treatment or in an ICSI procedure.
In the US, most urologists still use an operating microscope to recover epididymal sperm. This is called MESA – micro-epididymal sperm aspiration, which is very expensive and very time consuming. It also involves anesthesia and cutting open the scrotum.
|1. The testis is stabilised by stretching the skin tightly over it.|
|2. The turgid and full epididymis is palpated and identified|
|3. A very fine needle mounted on a tuberculin syringe filled with culture medium is inserted into the dilated epdidymal tubules through the taut skin.|
|4. Negative pressure is applied to aspirate the epididymal contents .|
|5. The needle is pulled out and the syringe withdrawn. This is then sent to the adjoining IVF lab for microscopic examination|
|6. The contents are expelled into a sterile petri dish|
|7. The culture medium containing the epdidymal fluid is then examined under an inverted microscope; and motile epdidymal sperm identified and used for ICSI after processing them|