Sperm Retrieval Procedures (TESA, TESE, PESA & MESA)
In some individuals, spermatozoa may not be present in the ejaculate. This condition
is called Azoospermia. This can be either due to problems in sperm production itself
or due to obstruction to the flow of semen during ejaculation. Reproductive tract
obstruction can be acquired – as a result of infection, trauma, an iatrogenic injury
that can occur during bladder neck, pelvic, abdominal or inguinoscrotal surgery.
Congenital anomalies may be relatively uncommon in the general population but can
occur in up to 2 percent of infertile men. The best-known condition is the congenital
bilateral absence of the vas deferens (CBAVD) which occurs in almost all men with
Two techniques – Epididymal sperm retrieval & micromanipulation have revolutionized
the treatment of male infertility in the past decade. Men with congenital bilateral
absence of the vas defenses (CBAVD) or reproductive tract obstruction are now able
to achieve pregnancies with the use of these advanced techniques.
PESA or Percutaneous Epididymal Sperm Aspiration (PESA), does not require a surgical
incision. A small needle is passed directly into the head of the epididymis through
the scrotal skin and fluid is aspirated. The embryologist retrieves the sperm cells
from the fluid and prepares them for ICSI.
Microsurgical Epididymal Sperm Aspiration (MESA) is used in conditions like obstructive
azoospermia, involves dissection of the epididymis under the operating microscope
and incision of a single tubule. Fluid spills from the Epididymal tubule and pools
in the Epididymal bed. This pooled fluid is then aspirated. Because the epididymis
is richly vascularized, this technique invariably leads to contamination by blood
cells that may affect sperm fertilizing capacity in vitro.
TESA And TESE
TESE or testicular sperm extraction is a surgical biopsy of the testis whereas TESA
or testicular sperm aspiration is performed by inserting a needle in the testis
and aspirating fluid and tissue with negative pressure. The aspirated tissue is
then processed in the embryology laboratory and the sperm cells extracted are used