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Percutaneous Epididymal Sperm Aspiration (PESA)

2 April 2009

Percutaneous Epididymal Sperm Aspiration (PESA): A needle is passed through the scrotal skin and into the epididymis in order to aspirate sperm. Because the epididymal tubule is very delicate and convoluted, the yield with a needle is typically small and usually only sufficient for a single cycle of IVF-ICSI performed on the same day as the PESA. Occasionally sperm may not be reliable retrieved at all.

PESA can be used for men with congenital absence of the vas and in lieu of vasectomy reversal. This procedure involves insertion of a small needle, under local anesthesia, directly into the epididymis for aspiration of a fewer number of sperm than would be necessary for fertilization by conventional IVF. However, in most cases there are more than enough sperm to fertilize all oocytes by ICSI. With newer cryopreservation techniques, there may even be sufficient numbers of sperm for freezing so that additional ICSI procedures could be performed in the future without the need to obtain more fresh sperm.

What are the advantages of PESA?
The advantages to this technique are that it can be performed without surgical scrotal exploration, it can be repeated easily and at low cost, and it does not require an operating microscope or expertise in microsurgery.

How is PESA done?
The procedure as described by Craft et al. has been performed under local or general anesthesia. After induction of anesthesia, the testis is stabilized and the epididymis is held between the surgeon’s thumb and forefinger.

What is the success rate for PESA?
PESA has the main benefits of being successful in most of the cases, while avoiding a skin incision. Costs are lower because an operating microscope, the skills of a microsurgeon, and the possibility of a general anesthetic are not necessary or likely. The most significant drawback is the blind nature of the procedure, often requiring multiple, potentially damaging needle insertions. The delicate, coiled anatomy of the epididymal tubules are easily damaged with such maneuvers. While PESA may be successful for someones first ICSI cycle, future cycles will require repeated procedures and the increased likelihood of progressive epididymal damage.