A Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Aspiration (TESA) are surgical procedures that are used (typically in conjunction with IVF) to find and extract sperm from the male partner who does not have sperm in his semen/ejaculate.
A PESA/TESA may be a good choice for you if the male partner has one of the following:
- Those having undergone a vasectomy or unsuccessful vasectomy reversal
- Those with insufficient sperm production
- Those having a congenital absence of the vas deferens (common in cystic fibrosis carriers)
- Those otherwise having a blockage of the reproductive tract
If you’re wondering how it is possible for there to be sperm in the testes if there isn’t in the ejaculate, you’re not alone.
Successful sperm production and delivery depend on a system of tubes in the testes and other reproductive organs. Remember sperm carry the genetic material, semen is the collection of liquid, proteins, sugar and sperm. Sperm production begins in the seminiferous tubules, a highly coiled set of tubes in the testes. These tubules are connected to another coiled tube, the epididymis which is connected to the vas deferens.
In order for sperm to be present in the ejaculate, the sperm must first be made and then transferred through these tubes to be mixed with semen prior to ejaculation.
PESA/TESA can be helpful because oftentimes azoospermia (no sperm) is caused not by a failure in sperm production, but by a blockage or obstruction of the epididymis or vas deferens (known as obstructive azoospermia) and thus can be retrieved by aspirating the testes before the blockage. In other cases, non-obstructive azoospermia, sperm production is simply too small to be detected in semen despite its occasional presence.
Sperm is retrieved during a PESA/TESA by aspirating various parts of the male reproductive tract to retrieve the necessary sperm for an IVF with ICSI procedure.
For a PESA, a fine needle will be inserted into the epididymis (where the seminiferous tubules are) to obtain the sperm. A TESA is similar; however, in a TESA the fine needle is passed directly into the testes in order to retrieve a small number of sperm from the seminiferous tubules.
Both surgical procedures can be performed under local or general anesthesia depending on your preference.
After the sperm is extracted with a PESA/TESA it will be treated by the andrology team and prepared for an IVF ICSI procedure in our embryology lab.
IVF done in conjunction with a PESA/TESA has a similar success outcome as to IVF done with sperm obtained through a standard ejaculation collection.