Surgical Sperm Retrieval (TESA/PESA/MESA)

Tests required before surgical sperm retrieval

A man who has no sperm in his semen is said to have azoospermia. This occurs due to the blockage in any of the tubes carrying sperm from the testes where they are produced, towards the penis during ejaculation. Obstructive azoospermia could be a result of testicular cancer, as the tumor presses against the vas deferens. This cancer commonly occurs in young men and can be treated successfully. Unfortunately, it can lead to male infertility, thus surgical sperm retrieval is necessary to store some sperm before starting the treatment.

Surgical Sperm-Retrieval

Other reasons that can cause non-obstructive azoospermia, include an abnormal cystic fibrosis gene. Men suffering from this condition fail to exhibit all the symptoms, but they often suffer a lack of vas deferens. Surgical sperm retrieval is possible but there is an equal chance that the embryos produced further by the process of ICSI and IVF will carry a similar genetic abnormality. The options that are then left are using a sperm donor and the use of intrauterine insemination (IUI) or even IVF. Pre-implantation genetic diagnosis (PGD) can also be carried out on the embryos for selecting the one that carries the normal gene.

Surgical sperm retrieval techniques are used when the obstruction is the problem

When the release of sperm is prevented by a blockage in the vas deferens, or by a vasectomy, several techniques can be used to retrieve the large numbers of sperm that remain inside the testes. The first three involve aspirating sperm using needles or tubes placed through the skin of the testis and are carried out under local anesthetic. The fourth requires open surgical sperm retrieval and is usually carried out under general anesthetic.

TESA refers to testicular sperm aspiration, which involves keeping a needle attached to a syringe through scrotum skin and drawing out the fluid from the testicle.
This refers to the percutaneous epididymal sperm aspiration. This also makes use of the same needle and syringe technique but in this case, the needle is put directly into the epididymis.
Perc biopsy:
Perc biopsy is the short form for percutaneous biopsy of the testis. This is quite close to TESA, but it makes use of a larger needle, which is a 14 gauge needle used for biopsy of the testicular tissue and it usually extracts a large number of sperm.
MESA is the microsurgical epididymal sperm aspiration that is the technique of open surgical sperm retrieval using operating microscopy for locating the tubules of the epididymis precisely, for the extraction of large numbers of sperms.

Certain studies have been conducted for comparing the success rates after doing the different types of sperm retrieval through surgery. MESA is thus known to give the highest number of sperm, recovered when compared with procedures like TESA and perc biopsy.

MESA produced sperms, which were better swimmers and thus more effective for infertility treatments, including IVF and ICSI..

Surgical sperm retrieval techniques when there is no obstruction

Men who lack any sperm in their semen, even after having clear tubes in their testicles, have an underlying problem with the process of sperm production. It is very less likely that sperm are present in large numbers, so the sperm retrieval through surgical techniques required are more invasive.

  • TESE: it refers to testicular sperm extraction that involves opening up the scrotum through a surgical incision and then taking a chunk of testicular tissue, derived from several regions of the testicle. Sperm are then extracted using a microscope for taking out the individual sperm.
  • Microdissection TESE. It is a similar technique using a micro dissecting microscope that is used to remove the tissue through a pinpoint. This procedure is helpful as it causes less damage to the structure inside the testicle, and thus has very less side effects like problems with blood supply by cutting with tiny blood. It can also enhance the number of sperm that are to be retrieved.

The main techniques used for the retrieval of sperm surgically are

PESA: the pit is the percutaneous epididymal sperm aspiration.
MESA: it refers to microsurgical epididymal sperm aspiration.
TESA: TESA refers to testicular sperm aspiration. This process includes testicular fine needle aspiration (TFNA).
TESE: This method is also known as testicular sperm extraction.

Microdissection TESE

Perc biopsy: this process refers to the percutaneous biopsy of the testis. Which method will be used depends upon what the underlying problem is in the male partner, which needs complete and careful evaluation first.

Which method is used depends on the nature of the problem in the male partner, which needs to be explored carefully first.

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