Surgical – Azoospermia / TESA, PESA, MESA, Micro TESA–Treatment for male infertility
A man is said to have azoospermia when he produces no sperm in his semen. A low sperm count is a common cause of male infertility. The latest surgical sperm retrieval techniques combined with intracytoplasmic sperm injection or in vitro fertilization can help overcome infertility problem even in men who produce hardly any sperm.
It is easy to collect sperm even if a man produces the tiniest number of sperm in his semen. Men who ejaculate no sperm, due to any genetic condition that prevents their sperm being released or due to blocked tubes in their testes, require some form of surgical sperm retrieval.
Surgical sperm retrieval techniques-
Several sperm retrieval techniques can be used to retrieve the large numbers of sperm when the release of sperm is prevented by a blockage in the vas deferens, or by a vasectomy.
Methods of surgical sperm retrieval
Testicular sperm aspiration (TESA)
- For men who are having sperm retrieved for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), Testicular sperm aspiration (TESA) is performed.
- Local anesthesia is needed to perform this procedure. It is coordinated with their female partner’s egg retrieval.
- A needle attached to a syringe is placed through the skin of the scrotum to suck out the fluid present inside the testicle.
- TESA is performed for men suffering from obstructive azoospermia.
Percutaneous epididymal sperm aspiration (PESA)
- This procedure is performed for men suffering from obstructive azoospermia from either a prior vasectomy or infection and who are now having sperm retrieved for IVF or ICSI.
- It is also done with local anesthesia and is coordinated with their female partner’s egg retrieval.
Microepididymal sperm aspiration (MESA)
- For men who have vasal or epididymal obstruction, MESA is performed.
- Either this procedure is done as a scheduled one or it is coordinated with the egg retrieval of their female partner.
- For this procedure, general anesthesia is required that utilizes the operating microscope.
- During this procedure, patients usually cryopreserve sperm for future in vitro fertilization or intracytoplasmic sperm injection.
- This procedure allows an extensive collection of sperm as compared to aspiration techniques.
For men with congenital bilateral absence of the vas deferens (CBAVD), it is generally the preferred method of sperm retrieval.
Microdissection TESE (microdissection testicular sperm extraction)
- For men who have a sperm production problem and are azoospermic, microdissection TESE is performed. It is performed with general anesthesia under the operating microscope.
- It is performed the day before egg retrieval and is carefully coordinated with the egg retrieval of female partner. It allows each partner to be there for the other’s procedure.
- In azoospermic men, it has significantly improved sperm retrieval rates. It is considered safe as in this procedure less testicular tissue is removed.
- During this procedure, patients cryopreserve sperm for future in vitro fertilization or intracytoplasmic sperm injection.