Male Infertility

TESA (Testicular Sperm Aspiration) is the procedure used to treat certain types of male infertility, particularly in cases where sperm cannot be found in the ejaculate due to either obstructive or non-obstructive azoospermia.

Infertility Conditions Addressed by TESA

TESA is primarily used for men with obstructive azzoospermia which is a condition that occurs when sperm production in the testes is normal, but there is a blockage in the male reproductive tract that prevents sperm from appearing in the ejaculate. This procedure is also used for non-obstructive azoospermia which is condition in which the testes fails to produce adequate sperm due to factors such as genetic issues, hormonal imbalances, or other unknown reasons.

Procedure of TESA

Preparation: The patient receives local anesthesia to numb the area, ensuring comfort during the procedure.

Aspiration: A fine needle is inserted into the testicle to aspirate (draw out) fluid and tissue containing sperm directly from the seminiferous tubules, where sperm is produced.

Sperm retrieval: The extracted sample is then examined in the laboratory to isolate viable sperm.

Processing and storage: Viable sperm are processed and can either be used immediately for Intracytoplasmic Sperm Injection (ICSI) in conjunction with In Vitro Fertilization (IVF), or they can be frozen for future use.

Benefits of TESA

Minimally invasive: TESA is less invasive compared to other surgical sperm retrieval methods like Testicular Sperm Extraction (TESE), resulting in quicker recovery and less discomfort.

Effective for severe cases: It provides a viable option for men with severe forms of azoospermia who otherwise have limited fertility treatment options.

Combination with ICSI/IVF: TESA can be effectively combined with ICSI and IVF to facilitate fertilization, increasing the chances of achieving pregnancy.

Avoidance of more extensive surgery: In cases of obstructive azoospermia, TESA can be a preferable alternative to more extensive surgeries aimed at removing blockages.

Microsurgical Testicular Sperm Extraction (called Micro TESE) is the most advanced technique of sperm retrieval. In this technique surgeon can directly retrieve sperms from testis with the help of special microscope. Specially trained Andrologist Surgeon performs this procedure

Infertility conditions addressed by Micro TESE

Micro TESE is typically recommended for men diagnosed with azoospermia, a condition where no sperm are present in the ejaculate. It is specifically suitable for those with non-obstructive azoospermia. Sperm obtained during Micro TESE can be cryopreserved for future use in ICSI procedures.

Procedure of Micro TESE

Micro TESE is performed in the operating room under general anesthesia and with the help of a microscope. During the TESE procedure the surgeon makes an incision (cut) in the scrotum and uses a high-powered microscope to look for swollen seminiferous tubules, which have a higher chance of containing sperm.

In cases where sperm cannot be found in the male partner, donor sperm may serve as a backup option.

Benefits of Micro TESE

The main advantage of Micro TESE is higher chance of Sperm retrieval compared to conventional TESE, as it targets specific areas of the testicular tissue, it increases the likelihood of finding viable sperm while minimising unnecessary tissue removal. This precision reduces the risk of damage to blood vessels, nerves, and the surrounding tissue.

Procedure of MESA

MESA is performed inserting a fine needle from scrotum to epididymis. Then with the help of an operating microscope, the dissection of the epididymis is done. When the incision is made on the epididymis tubules, the fluid spills from them and pools in the epididymis bed. This fluid is then aspirated and sent for processing in the laboratory, to extract sperms.

MESA is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval. Sperm found are used for IVF ICSI procedure. Once the sperms are extracted the ductule is closed. If no sperms are found another ductule is resected. If large number of sperms are obtained during MESA , it can be cryopreserved for future IVF ICSI attempts.

Benefits of MESA

MESA allows for an extensive collection of mature sperm as compared to aspiration techniques, and it is the preferred method of retrieval for men with congenital bilateral absence of the vas deferens as it does not impact steroid production of the testis. The clinical pregnancy rates using this sperm retrieval technique has been really good.

However, MESA requires highly experienced microsurgeons and operating microscope and thus the cost involved in this procedure is high.

Percutaneous Epididymal Sperm Aspiration (PESA) serves as a solution for men facing obstructive azoospermia, a condition where sperm cannot pass through the reproductive tract due to blockages. This minimally invasive procedure retrieves sperm from the epididymis, often performed under local anesthesia in an office or operating room. It is usually coordinated with the female partner's egg retrieval for IVF/ICSI, providing hope for couples dealing with male infertility.

Additionally, PESA involves inserting a needle into the epididymis to extract sperm-containing fluid, which is then used for intracytoplasmic sperm injection (ICSI) during IVF. This same-day procedure eliminates the need for surgical incisions and has proven highly effective for retrieving viable sperm.

PESA is a suitable option for men who have difficulty releasing sperm naturally and require assistance in retrieving sperm for fertility treatments like IVF/ICSI.