Did you know that 1 in 100 men have no sperm in their semen? This happens when there is a problem in sperm production, or there is an obstruction in the path of the sperm. In such situations, standard infertility treatments may not be useful. The best option for a couple to become pregnant in such cases is to retrieve the male sperms surgically.
Percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) are two simple procedures for retrieving sperms surgically. These procedures are usually done before intracytoplasmic sperm injection (ICSI), a specialised invitro fertilisation technique which involves injection of a single sperm directly into the female egg.
In PESA and TESA, a fine syringe is inserted into either the epididymis or the testicle to extract the sperm.
TESA/ PESA procedures are recommended when the absence of sperm in the semen is because of blockage of the male reproductive tract (obstructive azoospermia).This may occur when the male has:
1. Recently had a vasectomy
2. A history of sexually transmitted infections such as chlamydia.
PREPARATION BEFORE PROCEDURE
Before the procedure, your detailed health check would be done, and your genitals would be examined. You may also be recommended to undergo a few blood tests and produce a semen sample, if possible. Let your doctor know if you want your sperms to be frozen.
1. Percutaneous epididymal sperm aspiration (PESA):
This is an outpatient procedure and is done under local anaesthesia. In this procedure, the doctor would insert a needle attached to a syringe into the epididymis and gently remove fluid from there.
2. Testicular sperm aspiration (TESA)
If PESA is unsuccessful or not possible, TESA is performed. This procedure is also done under local anaesthesia. In this, the doctor would insert a needle attached to a syringe into the testicles and gently remove fluid from there.
The fluid that is retrieved is sent to the laboratory to check for motile sperm. If normal sperm is not retrieved with PESA, TESA is done.
These two procedures can be done in a few minutes and can also be used for diagnostic purposes.
Out of the two, PESA is more preferred by the patients as after this procedure, the patient is sent home in a few hours after surgery and can resume work the next day. In TESA, the patient may experience some pain, discomfort and swelling after the procedure.
Both the procedures are well tolerated. You may be asked to go back home the same day of the procedure. If you have pain, your doctor will prescribe pain medications such as Ibuprofen. You may be asked to apply some ice on the scrotum for a day after the procedure. You can start regular work (non-strenuous) in a day or two. You doctor may ask you to refrain from engaging in sex for 4 days after the procedure
Follow these tips to recover faster:
1. Avoid doing any rigorous activities for 5 days post-procedure.
2. Check for any signs of infection such as pus in the scrotum.
3. Have a healthy and balanced diet when you are home.
4. Drink a lot of fluids.
FACTORS AFFECTING COST
The procedure cost varies depending upon:
- The technology used
- The method of retrieval
- The expertise of the doctor
Like any procedure, TESA/ PESA also have some risks such as bleeding, infection or formation of a blood clot.
Chemotherapy treatment often leads to fertility problems. You seem to have non- obstructive azoospermia, which means that there is deficient production of sperms by your testes. You could choose to undergo microscope-assisted testicular sperm extraction (MicroTESE). In this procedure, the testicles are opened with a small incision, and then a high-powered microscope is used to see the seminiferous tubules that contain sperm. Next, a sample of the seminiferous tubule tissue is taken. This tissue is sent to the lab to check for the presence of sperms. Usually, sperms can be identified and procured by this procedure.
If PESA/TESA procedures don’t work, your doctor may ask you to undergo more invasive procedures like - testicular sperm extraction (TESE), and microscope-assisted testicular sperm extraction (Micro TESE).
Standard health insurance plans usually do not cover fertility and assisted reproductive treatments like PESA/ TESA, Invitro fertilization (IVF), intrauterine insemination (IUI).
TESA is a simple sperm retrieval procedure. If you are undergoing IVF, TESA would be done on the same day as the female egg retrieval procedure. This is because most laboratories prefer fresh sperms for IVF rather than frozen.