PESATESAMESA


During normal fertilization, millions of sperms swim to fertilize an egg of which ultimately only one sperm penetrates the egg. In case of men with fertility problems, such as low sperm count or no sperm natural fertilization becomes difficult. Modern Fertility Treatments like ICSI (Intra Cytoplasmic Sperm Injection) and In Vitro Fertilization(IVF) make it possible to extract a single sperm from the male and use it to fertilize the egg. Even in men who produce hardly any sperm, it is possible to overcome fertility problems using the latest sperm retrieval techniques.
In case of men who produce even a little amount of sperm it can be retrieved easily. In case of men who do not eject any sperm due to blocked vas deferens or a congenital defect, it can be collected surgically. The absence of sperm from a semen sample is known as Azoospermia.

  • Obstructive Azoospermia is due to the blockage of vas deferens that carry sperm from testicles to penis. This blockage could be due to testicular cancer, due to vasectomy or could be a congenital disorder. Congenital disorder is associated with cystic fibrosis wherein the vas deferens is either malformed or absent. If you have been diagnosed with this congenital disorder, then it is advised to discuss with your specialist the risk of passing it on to your children who can advise you with the right treatment options.
  • Non- Obstructive Azoospermia is caused by hormonal problems, testicular failure and varicocele. Testicular failure could be caused by chromosomal defects such as Klinefelter’s Syndrome or abnormalities with the Y chromosome. In case of chromosomal defects, there is a risk of the male child inheriting this disease. Hence it is advised to discuss the risks with your specialist who can suggest the right treatment method.

Obstructive Azoospermia can be overcome by surgical retrieval of sperm using the following techniques:

  • PESA or Percutaneous Epididymal Sperm Aspiration
  • TESA or Testicular Sperm Aspiration
  • MESA or Microsurgical Epididymal Sperm Aspiration

PESA
It is a simple technique used to obtain sperm for ICSI treatment. This is employed in men where there is a block in the vas deferens either due to vasectomy or some other reason. The procedure involves passing a fine needle through the scrotal skin into the epididymis (this is where the sperm are stored after production in the testis) to aspirate the seminal fluid. Motile Sperm is isolated from this seminal fluid by an andrologist. It is performed under a local anesthesia or GA. It is usually attempted on one side to minimize scarring and damage. In 80% of the cases sufficient sperm is obtained for ICSI. This procedure may have to be repeated until motile sperm is retrieved. It is usually done on the same day as oocyte collection in female partner. Your doctor may prescribe mild painkillers in case of discomfort if any.

TESA
TESA is a surgical sperm harvesting technique used to retrieve sperm for IVF-ICSI. The procedure involves passing a small needle into the testicle through the scrotal skin. A very small amount of testicular tissue is retrieved using syringe suction and numerous excursions of the needle. The procedure is usually performed under a local anesthesia. In case no sperm is retrieved or in case of poor sperm production, multiple incisions are made in the testicles to locate the area of exact sperm production for subsequent TESE or Testicular Sperm Extraction. The procedure is usually done on the same day as egg collection from the female partner.

MESA
It is a surgical procedure used to retrieve sperm in men diagnosed with blockage in vas deferens. It is usually carried out under a general anesthesia. The procedure involves making a small incision in the scrotal skin. The tiny epididymal tissues are incised using optimal magnification and the sperm rich fluid is aspirated. The sperm retrieved through this technique can either be used in ICSI immediately or can be stored for future use. It can be performed well in advance of any proposed IVF procedure.


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