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Sperm aspiration from the epididymis or testicle - PESA or TESA - and then ICSI and IVF

Sperm can be aspirated with a needle from the testicle or from the vas deferens (a structure right next to the testicle that also contains sperm). The man is given some drugs to sedate him and some local anesthesia is also used to numb the area. Then a small needle is inserted and sperm is aspirated from either the epididymis or the testicle. There should be no severe pain. The procedure generally takes about 30 minutes.

The different sperm aspiration and extraction procedures have long names and also short names (acronyms) : -
  • PESA - Percutaneous Epididymal Sperm Aspiration (can be done in the office)

  • TESA - Testicular Sperm Aspiration (can be done in the office)

  • TESE - Testicular Sperm Extraction (involves a small incision and snipping off some tissue from inside the testicle - often done in a hospital or free-standing surgicenter)
PESA (percutaneous epidydimal sperm aspiration) and TESA (testicular sperm aspiration) are procedures that are performed to obtain sperm in certain cases of male infertility. PESA or TESA can be performed on men that have zero sperm counts due to either a sperm production problem or a blockage in their reproductive tract, such as the result of a vasectomy, congenital absence of vas deferens, or infection.

Once a diagnosis of azoospermia (zero sperm count) has been made, we work closely with a urologist with specialized training in male infertility who will retrieve the sperm. The urologist will first perform an exam and further testing which may involve blood work and/or a testicular biopsy. The result of these studies determine which procedure is more appropriate and more likely to yield sperm.

While PESA is usually performed in our Center the morning of the egg retrieval, TESA may be done the day prior to the egg retrieval to allow in vitro maturation of immature sperm. With PESA, a small needle is placed into the epidydimis, which is a reservoir of sperm that sits atop each testicle, using local anesthesia. During TESA, sperm is obtained by means of a biopsy of the testicle. The sperm obtained from these procedures is then injected directly into the eggs (ICSI).

The injection of a single sperm directly into the center of an egg (ICSI) has now become the treatment choice for couples with a severe male factor. Pregnancy is prevented because poor sperm lack the progressive motility required to break through the outer membrane of the egg (zona pellucida) to achieve fertilisation. Select IVF Surrogacy India's partner fertility centres have performed over 4000 ICSI procedures. Only 7% of patients fail to achieve fertilisation. The first babies were born in 1994, and since then many healthy babies have followed.

The same technology (ICSI) may be used with sperm recovered from those with an irreversible obstruction to the outflow of sperm from the testis, for example men who have no sperm in the ejaculate (azoospermia). Nowadays, this is most frequently due to a failed vasectomy reversal. Other irreversible obstructions include patients with an absent vas, or from previous severe infection.

The procedure can be done under local anaesthesia or short intravenous sedation. For aspiration of sperm from the epidydymis (so called PESA) as well as for aspiration of sperm directly from the testicles (so called TESA) we use special, fine needles which make the procedure less invasive.

PESA/TESA takes about 15-20 minutes and sperm aspirated during that procedure are usually cyropreserved and are to be used for ICSI (IVF with injection of a single, selected sperm) on the day of the egg collection.

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