In some situations of male infertility, procedures called PESA (percutaneous epidydimal sperm aspiration) and TESA (testicular sperm aspiration) are used to collect sperm. Men who have zero sperm counts because of a sperm production issue or an obstruction in their reproductive tract, such as the result of a vasectomy, congenital vas deferens absence, or infection, can undergo PESA or TESA.

We collaborate closely with a urologist with specific knowledge in male infertility who will collect the sperm once azoospermia (zero sperm count) has been diagnosed. Prior to any further examinations or testing, the urologist will do an examination and possibly even a testicular biopsy. Which approach is more suitable and more likely to produce sperm depends on the findings of these investigations.

While PESA is often carried out in our Center on the morning of the egg retrieval, TESA may be carried out the day before to allow immature sperm to mature in vitro. With PESA, a tiny needle is inserted under local anesthesia into the epididymis, a sperm reserve located on top of each testicle. Sperm is retrieved via TESA using a testicular biopsy. Following these treatments, the eggs are given a direct injection of the sperm (ICSI).

TESA / PESA – Who Needs It

Azoospermia comes in two forms: non-obstructive azoospermia, which occurs when sperm are not created within the testes, and obstructive azoospermia, which occurs when sperm are produced within the testes but are blocked from exiting through the ejaculate. Obstructive azoospermia is the name given to this form of azoospermia.

To determine the reason for azoospermia, your IVF specialist will request a few hormone tests as well as a scrotal USG. The IVF specialist will try testicular or epididymal sperm aspiration to remove sperm from the testes or epididymis if the results indicate a patient has obstructive azoospermia.

Congenital bilateral lack of the vas deferens is one such instance of obstructive azoospermia (CBAVD). One of the most frequent causes of obstructive azoospermia in males is this. In this condition, sperms are produced in the testes, but the Vas deferens, a tube structure that transports sperm from the testes into the ejaculate, is absent.

When are TESA and PESA carried out?

When a man's capacity to naturally release sperm via ejaculation is compromised by obstruction of the vas deferens or epididymis, TESA and PESA are typically performed. However, PESA includes injecting a tiny needle into the epididymis to collect sperm, whereas TESA involves injecting a tiny needle right into the testicles to harvest sperm. The following is a discussion of some of the circumstances that can necessitate performing TESA and PESA.

Azoospermia

Between 10% and 15% of the causes of male infertility are conditions where a man's ejaculate is devoid of sperm. An obstruction in the sperm delivery system or a decrease in the quantity of sperm generated in the testes could be the cause of this. Depending on the severity of a man's obstructive or nonobstructive azoospermia, sperm can be extracted using PESA or TESA. PESA will be employed if there is sperm in the epididymis, and TESA will be the best sperm retrieval method if there isn't.

Testicular failure

A male may develop testicular failure as a result of chromosomal abnormalities brought on by diseases like Klinefelter's syndrome or other abnormalities of the Y chromosome. Due to this condition, the testicles were less able to produce and store enough sperm for them to enter the woman's uterus during ejaculation. In this situation, sperm from the testicles or epididymis may be extracted for IVF using PESA or TESA.

Varicocele

Benign testicular cysts that may develop as a result of an accumulation of varicose veins growing in the spermatic cord or epididymis are the defining feature of this disorder. This could result in obstructions that unquestionably impact the sperm's ability to exit the testicles and epididymis. The best techniques to recover sperm from a guy with this disease are TESA or PESA.

Steps Involved in TESA and PESA

PESA:-

Administration of Anesthesia

PESA is typically carried out under local anaesthesia, which entails injecting the anaesthetic right into the scrotum. This is intended to numb the area, preventing pain throughout the entire treatment.

Extraction of Sperm

Once the vas deferens has been identified, a tiny needle will be placed into it or into the epididymis, and the plunger will be pulled out to aspirate seminal fluid into a syringe.

Testing of the Testes

The doctor next cleans the area around the scrotum with a warm antiseptic swab before starting the surgery. The testes are next inspected by feeling the vas deferens in the scrotum. This is also done to look for obstructions or irregularities.

Examining sperm for motile sperm

An embryologist then checks the collected seminal fluid for motile or migrating sperm. If there aren't enough sperm, PESA will be carried out again until there are enough.

TESA: -

After completing all PESA procedures, TESA is carried out if there is no sperm in the vas deferens or epididymis. Testicular tissue will be extracted from the testes and injected with a tiny needle directly into the testes and testicles. Similar to PESA, TESA requires that a sufficient amount and quality of sperm be obtained. PESA and TESA are excellent options for couples, far superior to intrauterine insemination with donor sperm since they allow the guy a tremendous chance to contribute to the genetic makeup of their unborn child.

Recovery

Recovery from TESA and PESA only requires one day because they are both outpatient procedures. The patient is typically instructed to wear form-fitting pants after the surgeries to support the scrotum. Additionally, the patient receives a dose of painkillers. The patient is typically permitted to leave the hospital or clinic on the same day because it is minimally invasive.

TESA and PESA carried out-

When a man's capacity to naturally release sperm via ejaculation is compromised by obstruction of the vas deferens or epididymis, TESA and PESA are typically performed. However, PESA includes injecting a tiny needle into the epididymis to collect sperm, whereas TESA involves injecting a tiny needle right into the testicles to harvest sperm.

Tesa procedure duration-

It takes 20 to 30 minutes to complete the process. Recovery takes less time and is far less painful. A nearly one-week recuperation period may be necessary following open testicular surgery.

When are TESA and PESA carried out?

When a man's capacity to naturally release sperm via ejaculation is compromised by obstruction of the vas deferens or epididymis, TESA and PESA are typically performed. However, PESA includes injecting a tiny needle into the epididymis to collect sperm, whereas TESA involves injecting a tiny needle right into the testicles to harvest sperm. The following is a discussion of some of the circumstances that can necessitate performing TESA and PESA.

Azoospermia

Between 10% and 15% of the causes of male infertility are conditions where a man's ejaculate is devoid of sperm. An obstruction in the sperm delivery system or a decrease in the quantity of sperm generated in the testes could be the cause of this. Depending on the severity of a man's obstructive or nonobstructive azoospermia, sperm can be extracted using PESA or TESA. PESA will be employed if there is sperm in the epididymis, and TESA will be the best sperm retrieval method if there isn't.

Testicular failure

A male may develop testicular failure as a result of chromosomal abnormalities brought on by diseases like Klinefelter's syndrome or other abnormalities of the Y chromosome. Due to this condition, the testicles were less able to produce and store enough sperm for them to enter the woman's uterus during ejaculation. In this situation, sperm from the testicles or epididymis may be extracted for IVF using PESA or TESA.

Varicocele

Benign testicular cysts that may develop as a result of an accumulation of varicose veins growing in the spermatic cord or epididymis are the defining feature of this disorder. This could result in obstructions that unquestionably impact the sperm's ability to exit the testicles and epididymis. The best techniques to recover sperm from a guy with this disease are TESA or PESA.

Steps Involved in TESA and PESA

PESA:-

Administration of Anesthesia

PESA is typically carried out under local anaesthesia, which entails injecting the anaesthetic right into the scrotum. This is intended to numb the area, preventing pain throughout the entire treatment.

Extraction of Sperm

Once the vas deferens has been identified, a tiny needle will be placed into it or into the epididymis, and the plunger will be pulled out to aspirate seminal fluid into a syringe.

Testing of the Testes

The doctor next cleans the area around the scrotum with a warm antiseptic swab before starting the surgery. The testes are next inspected by feeling the vas deferens in the scrotum. This is also done to look for obstructions or irregularities.

Examining sperm for motile sperm

An embryologist then checks the collected seminal fluid for motile or migrating sperm. If there aren't enough sperm, PESA will be carried out again until there are enough.

TESA: -

After completing all PESA procedures, TESA is carried out if there is no sperm in the vas deferens or epididymis. Testicular tissue will be extracted from the testes and injected with a tiny needle directly into the testes and testicles. Similar to PESA, TESA requires that a sufficient amount and quality of sperm be obtained. PESA and TESA are excellent options for couples, far superior to intrauterine insemination with donor sperm since they allow the guy a tremendous chance to contribute to the genetic makeup of their unborn child.

Recovery

Recovery from TESA and PESA only requires one day because they are both outpatient procedures. The patient is typically instructed to wear form-fitting pants after the surgeries to support the scrotum. Additionally, the patient receives a dose of painkillers. The patient is typically permitted to leave the hospital or clinic on the same day because it is minimally invasive.

TESA and PESA carried out-

When a man's capacity to naturally release sperm via ejaculation is compromised by obstruction of the vas deferens or epididymis, TESA and PESA are typically performed. However, PESA includes injecting a tiny needle into the epididymis to collect sperm, whereas TESA involves injecting a tiny needle right into the testicles to harvest sperm.

Tesa procedure duration-

It takes 20 to 30 minutes to complete the process. Recovery takes less time and is far less painful. A nearly one-week recuperation period may be necessary following open testicular surgery.

Do's

Both operations are tolerated satisfactorily. On the day of the procedure, you might be requested to return home. Your doctor will recommend painkillers like ibuprofen if you are in pain. After the treatment, you could be instructed to apply some cold to your scrotum for a day. In a day or two, you can begin doing regular, non-strengthening work. After the operation, your doctor can advise against having sex for 4 days.

Dont's

•  For five days after the surgery, avoid engaging in any strenuous activity.

•  Look for any infection-related symptoms, such as pus in the scrotum.

•  You should not eat junk or unhealthy food.

•   Be sure to stay hydrated.