PESA (Percutaneous Epididymal Sperm Aspiration) Overview

Percutaneous epididymal sperm aspiration (PESA) is a sperm retrieval method that removes sperm. PESA can be carried out in advance or when the female partner is ovulating. If performed in advance, the sperm will need to be frozen (sperm freezing) and then stored until it is required for IVF with ICSI (microinjection). Epididymal sperm tolerates the freeze-thaw process very well. PESA is similar to a related technique called microsurgical epididymal sperm aspiration (MESA).

The main difference between the two is that MESA uses a microscope to help find sperm while PESA does not. During PESA, sperm are aspirated “blindly” from the epididymis through the skin. As PESA is a less invasive procedure than MESA, it is often attempted first. It can also be performed more than once in the same epididymis. PESA is considered to be the most successful when sperm production in the testis is normal. However, this method has a tendency to retrieve sperm that are less mature and have lower motility so repeated procedures may be required.

The main disadvantage of percutaneous epididymal sperm aspiration is that the sperm sample may be contaminated with blood. This is because the percutaneous puncture can damage blood vessels and the epididymal tubule. Another disadvantage is that low quantities of sperm are sometimes collected. PESA is generally an effective sperm aspiration technique and the subsequent IVF pregnancy rate compares favorably with other techniques.

The percutaneous epididymal sperm aspiration procedure is normally performed in an outpatient clinic under local anesthetic – with or without sedation. The recovery period for percutaneous epididymal sperm aspiration (PESA) procedure is about one day. Once 10-20 million sperm are retrieved, the epididymal tubule is closed with a microscopic stitch and the sperm are further processed.

The cost of PESA can vary between clinics and hospitals. Many people choose to travel abroad for this medical procedure because it is often cheaper than back home. By doing this, they can save money and have a relaxing holiday at the same time. If they are having a combination of infertility treatments, the savings can reach into the thousands of dollars.

A Good Candidate for PESA (Percutaneous Epididymal Sperm Aspiration)

To be a good candidate for percutaneous epididymal sperm aspiration (PESA), you need to fit a number of criteria. When you first arrange a consultation with your infertility specialist, he will talk to you about what your options are and which one is the best for you.

There are a variety of sperm retrieval techniques that can be used to help couples with male factor causes of infertility to become pregnant. These include Microdissection TESE and Testicular Sperm Aspiration (TESA).

All sperm aspiration methods can be carried out in advance of the female partner’s ovulation or at the same time. IVF with ICSI (microinjection) can be carried out once healthy sperm and egg cells have been obtained.

Patients Who Are Good Candidates for PESA:

· Capable of normal sperm production but no sperm

· Men who have no sperm in their ejaculate because they were born with no vas deferens (the sperm-carrying tube). This is a condition referred to as congenital bilateral absence of the vas deferens (CBAVD)

· Men whose vas deferens is blocked/scarred as a result of a previous infection, trauma or vasectomy

· Men who have experienced a failed vasectomy reversal

· Patients who have already undergone earlier attempts may have the PESA procedure again

· A good candidate for PESA might be someone who suffers from anejaculation (absence of ejaculation) as a result of diabetes or a spinal cord injury.

· Men who have had a vasectomy but do not necessarily want to reverse it permanently. For example, they may only want one child and not worry about contraception again later. Also, a vasectomy reversal can be expensive and complicated

Patients Who Are NOT Good Candidates for PESA:

· Someone who might not be a good candidate for PESA is a man with non-obstructive azoospermia. This is because they don’t have normal sperm production and so don’t usually have sperm present in their epididymis for retrieval

· A sperm aspiration method such as PESA in these men may fail to recover enough healthy sperm so another method may be required

PESA (Percutaneous Epididymal Sperm Aspiration) Procedure

The percutaneous epididymal sperm aspiration (PESA) procedure is performed on men who are having sperm retrieved for IVF treatments. PESA is designed to help retrieve sperm from men suffering from obstructive azoospermia due to prior vasectomy or infection.

The procedure is normally performed in an outpatient clinic under local anesthetic. If the patient requires sedation, it can also be administered. PESA does not take very long (patient is discharged after 1-2 hours) and the recovery time is about one day. Mild discomfort in the groin area after the PESA procedure can be managed with regular pain medication.

A needle is placed into the epidymis (a tube that connects the efferent ducts of each testicle to its vas deferens) to explore for a pocket of sperm will be found and aspirated.

PESA is considered to be a “blind” procedure because the surgeon cannot see where he is putting the needles. Once 10-20 million sperm are retrieved, the epididymal tubule is closed with a microscopic stitch and the aspirate is flushed into a culture medium before being processed.

Some advantages of the PESA procedure include:

· It is successful in most cases

· It avoids a skin incision

· Costs are lower because a microscope and the skills of a micro surgeon are not necessary

· It is preferable to open surgery because it does not require general anesthetic and is technically easier

Some disadvantages of the PESA procedure include:

· If a blood vessel is accidentally damaged it may continue to bleed and result in a hematoma

· There can be a high rate of complications e.g. damage to the delicate epididymal tubules

· The blind nature of the procedure may require multiple, potentially damaging needle insertions

· May not be successful in obtaining enough suitable sperm cells and so require alternative infertility treatments such as Testicular Sperm Aspiration (TESA)

Costs of PESA (Percutaneous Epididymal Sperm Aspiration)

The cost of PESA depends on a number of factors: the surgical fees of the specialist, facility fees and sperm freezing and storage.

The Surgical Fees for PESA: The specialist who carries out the PESA procedure will be an urologist who specializes in male fertility cases or a reproductive endocrinologist (infertility specialist). Fees typically increase with experience.

The Facility Fees for PESA: A hospital is generally more expensive than a clinic because it has higher running costs. There are various advantages and disadvantages of using each. For example, smaller clinics may not be well equipped enough to handle unforeseen circumstances. The location of the facility may also determine how much they charge patients, that is, certain central areas are able to charge more than places that are not considered to be as luxurious.

Sperm Freezing and Storage: The cost of PESA might sometimes include sperm freezing and storage but it is not always the case. Make sure you know exactly what you are paying for beforehand so there are no surprises at the end.

Percutaneous Epididymal Sperm Aspiration (PESA) is generally less expensive than MESA but only slightly less expensive than Testicular Sperm Aspiration (TESA).

The cost of PESA in countries such as the United States and the United Kingdom is around $2,000- $3,800. The cost of PESA abroad in countries such as India, Mexico and Cyprus is significantly less at $400-$2,000. Neither of these includes subsequent infertility treatments such as IVF with ICSI (microinjection). It is to your advantage to travel abroad for sperm aspiration and IVF because the cost of PESA is so affordable.