Percutaneous Epididymal Sperm Aspiration (PESA)
PESA is a simple technique to obtain sperm for Intracytoplasmic Sperm Injection (ICSI) in men who have an obstruction of the vas deferens, either due to vasectomy or other obstruction. To minimize scarring and damage, PESA usually is attempted on one side only. It is sometimes necessary to aspirate from both sides. Sufficient sperm for ICSI is obtained in 80% of attempts. In 10% of cases enough suitable sperm is found for cryopreservation.
The procedure is performed in the Canberra Fertility Centre rooms. After the procedure the man will be asked to wear a very tight pair of underpants to provide support to the scrotum. There is no other special preparation for the patient.
PESA is performed under local anaesthetic. This means that an anaesthetic is injected into the scrotum by the specialist to make the area numb. When this has been achieved the doctor will swab the scrotum with a warm antiseptic. The doctor will examine the testes to locate the vas deferens by gently feeling the scrotum. A small needle will be inserted into the vas deferens and the doctor will instruct the nurse assisting to draw back on the plunger in order to aspirate seminal fluid. When fluid is obtained it is passed to the andrologist to be examined for motile (moving) sperm. The procedure may need to be attempted again until motile sperm have been found.
The procedure is usually performed just prior to the woman’s oocyte collection (on the same day). If no sperm is retrieved the oocyte collection may be cancelled.
TESA & TESE :
TESA (Testicular Sperm Aspiration) involves the insertion of a needle into the testicle and aspirating the sperm/tissue for use in IVF-ICSI. On the other hand, TESE (Testicular Sperm Extraction) involves creating an incision in the testicle and retrieving sperm from the tubules therein. Both procedures can be performed with light levels of local anaesthesia or sedation and can help males who do not ejaculate sperm along with their semen. However, the TESE procedure has been largely replaced by microTESE as the best sperm retrieval method for men suffering from azoospermia.
Microdissection TESE – Also known as microTESE, the procedure is ideal for males who suffer from poor sperm production and who are azoospermic. It is performed under general anaesthesia using an operating microscope. MicroTESE has a significantly high sperm retrieval rate among men suffering from azoospermia. It’s also a much safer procedure as a minimal amount of testicular tissue is removed. Among different sperm retrieval techniques, the microTESE success rate is the highest.