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Testicular Sperm Aspiration – TESA

2 April 2009

Testicular Sperm Aspiration (TESA): A needle is passed through the scrotal skin into the testicle. With syringe suction and numerous excursions of the needle through the testicle tissue, a very small amount of testicular tissue can be retrieved. In the case of obstruction, it will usually be adequate for a cycle of IVF-ICSI that day, but typically not for freezing and subsequent use. In the case of poor sperm production, this technique may be performed through multiple entry points in the testicle in an effort to localize where sperm production may be occurring for subsequent open TESE.

TESA, or testicular sperm aspiration ( also known as TESE, or testicular sperm extraction) is one of the surgical sperm harvesting techniques used for retrieving sperm in patients with azoospermia. A number of surgical sperm retrieval or recovery methods have been devised to recover sperm from the male reproductive tract.

In men with obstructive azoospermia,( because of duct blockage or absence of the vas deferens) , sperm are usually recovered from the epididymis. The original technique was devised by a urologist, Dr Sherman Silber, who is a specialist in microsurgery. He used a method called MESA, or microepididymal sperm aspiration, in which the scrotum was opened, and an operating microscope used to identify the epididymal tubules which were distended with sperm. While this method was very successful, it was very complex , since it needed an operating microscope; and therefore very expensive as well. This is why a gynecologist from Dubai, Dr Pankaj Srivastav, developed a very simple and easy method to recover sperm from the blocked epidiymis. Since he could feel the turgid epididymis, swollen with sperm, he would blindly puncture the epididymis using a simple butterfly needle – a technique which was very similar to drawing blood from a blood vessel ! This simple technique is called PESA (percutaneous epididymal sperm aspiration), in which the sperm is sucked out from the epididymis by puncturing it with a fine needle.

This method is as effective as microsurgery to retrieve epididymal sperm ; is much easier for both the patient and the doctor; and much cheaper as well, since the infertility specialist can do it himself. It is also much less traumatic, since there is no need to cut the scrotum, with the result that there is no scar at all. This is why this is the preferred method of choice in most centers in India, UK and Belgium.

For patients with obstructive azoopsermia in whom sperm cannot be found in the epididymis, it is always possible to find sperm in the testis. The easiest way to retrieve this is through TESA or testicular sperm aspiration , in which the testicular tissue is sucked out through a fine needle, under local anaesthesia. The testicular tissue is placed in culture media and sent to the lab, where it is processed. The sperm are liberated from within the seminiferous tubules ( where they are produced ) and are then dissected free from the surrounding testicular tissue.