TESA or TESE: Which Is Better for Sperm Extraction?

Many azoospermic patients with nonobstructive azoospermia (NOA) might be candidates for sperm aspiration as part of their in vitro fertilization procedure. Because sperm might be present in some but not all parts of the testes of such men, multiple samplings of the testicular tissue are usually performed to increase the probability of finding sperm in NOA patients. These samplings can be done by 2 methods: 1) TESE (testicular sperm extraction), which is actually a surgical biopsy of the testis; or 2) TESA (testicular sperm aspiration), which is performed by sticking a needle in the testis and aspirating fluid and tissue with negative pressure. Sperm extraction is being performed more and more by non-urologists (called andrologists) who are actually either internists or obstetrician-gynecologists. It stands to reason that these non-urologists prefer TESA, given that they are not surgically trained. There has always been debate, however, as to which procedure is “better” at obtaining sperm for successful intracytoplasmic sperm injection.

To better answer this dilemma, Hauser and colleagues from Tel Aviv, Israel, compared the results of TESE with those from TESA in the same testis of NOA patients. Three samples by TESE and by TESA were taken in each testis, and the results were compared. The investigators found that TESE was markedly superior to TESA at obtaining sperm and in terms of the quantity and subsequent motility of the sperm found. This meant that there was a better chance of cryopre-servation of sperm obtained by TESE rather than TESA. The import of this is that such cryopre-served sperm can be used in subsequent cycles rather than the patient having to go through another TESE or TESA procedure.One of the “complaints” about TESE by non-urologists is that general anesthesia is necessary for such a procedure. This is not necessarily true: it can be done safely and comfortably with a cord block, as we perform it at the University of California, Los Angeles. Therefore, according to Hauser and colleagues’ data, it seems that TESE is the preferred method of sperm aspiration in men with NOA.