Information on methods of surgical sperm retrieval for cases of extreme male infertility.

What is PESA/TESA?

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 ?

PESA : 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 TESA. Dr Rupin Shah, Dr Vijay Kulkarni or Dr Gupte carry out this procedure.

TESA : 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 Bombay Fertility Clinic & IVF 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. This technique was innovated by Dr Rupin Shah and is very popular with our patients because of its painless nature.

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. BFC offers advice and counseling about possible genetic causes of male infertility.