Sperm aspiration methods in infertility treatments were designed to collect sperm from three different parts of the reproductive tract: the vas deferens, epididymis and testicles. Testicular sperm aspiration (TESA) is a procedure used to obtain sperm from the testicles.
TESA is a relatively new technique and does not involve surgery. The sperm obtained is intended for specific use in IVF with ICSI (microinjection).
This is because not enough sperm can be retrieved for use in intra uterine insemination (IUI). The IUI procedure requires larger quantities of healthy and motile sperm than IVF. If you so desire, you can get your sperm frozen for later use. This is particularly useful in cases where there is no ejaculate or no sperm in the ejaculate. It also means that you don’t have to undergo TESA again. Bear in mind that testicular sperm do not freeze or thaw as well as sperm obtained from other locations and they are also more challenging to work with in the laboratory.
TESA can be carried out on two types of patients: men with obstructive azoospermia (sperm production is normal but it can’t reach the ejaculate because there is a blockage) and men with non-obstructive azoospermia (sperm production is too low to even reach the ejaculate). In addition, men in certain situations or who have particular conditions can be good candidates for TESA as opposed to other aspiration techniques.
The cost of TESA varies significantly from location to location. Some clinics include most of the services in your final cost while other clinics only charge for the procedure itself. Be sure to discuss what you will actually be paying for with your fertility specialist. The cost of TESA abroad can often work out to be much more affordable and many medical tourists are travelling overseas so they can undergo this procedure.
There are a number of sperm retrieval procedures available so you should discuss which one is best suited for you with your fertility specialist. A good candidate for TESA may also be a good candidate for percutaneous epididymal sperm aspiration (PESA) or a good candidate for microdissection TESE.
There are significant advantages and disadvantages of each that need to be carefully considered. For example, patients undergoing the TESA procedure as an infertility treatment should be aware that testicular sperm is the least fertilizable.
Good Candidates for Testicular Sperm Aspiration
· Sperm aspiration techniques are usually carried out on men who have the most severe types of male factor infertility. These include azoospermia (no sperm in ejaculate), non-motile sperm or necrospermia (dead sperm)
· TESA can help men with obstructive azoospermia (their sperm production is normal but it can’t reach the ejaculate because there is a blockage somewhere). As sperm cells are not often present in the epididymal tissue of patients with this condition, procedures such as percutaneous epididymal sperm aspiration (PESA) are inappropriate for obtaining sperm from them
· TESA can also help men with non-obstructive azoospermia (their sperm production is too low to reach the ejaculate). However, men with this condition might need to have a few areas of their testis sampled before enough viable sperm cells are found
· Good candidates for TESA include men who can still produce sperm even though they can no longer ejaculate
· Men who have had their prostate removed
· Men with spinal cord injuries
· Men with neurological conditions (such as multiple sclerosis)
· If a man has had a vasectomy but later wants to reverse it, he may be a good candidate for TESA, if the procedure was carried out less than 10 years before
· If a vasectomy reversal has already been performed but it was unsuccessful, a second surgery is generally not recommended. In this case, the man would be a good candidate for TESA followed by IVF with ICSI (microinjection)
The TESA procedure is an infertility treatment that can be carried out on a patient with obstructive azoospermia or non-obstructive azoospermia. Obstructive azoospermia is when there is normal sperm production but it can’t reach the ejaculate because there is a blockage. A man with this condition has normal FSH and testosterone levels, had a testis biopsy that turned out to be normal or had a vasectomy.
Non-obstructive azoospermia is when sperm production is too low to reach the ejaculate. The testicular sperm aspiration (TESA) procedure is usually performed by a urologist who specializes in male fertility cases or by a reproductive endocrinologist (infertility specialist).
The TESA Procedure with Obstructive Azoospermia
· Testicular Sperm Aspiration is an outpatient procedure performed under local anaesthetic with or without sedation
· The TESA procedure can be carried out on the day of the wife's ovulation or at an earlier time. In this latter case, the sperm would be washed, frozen and stored (sperm freezing) until ready to be used and then thawed
· The sperm from the testis is retrieved by needle aspiration and does not require surgery
· Basically, the surgeon holds the testis in his hand and then inserts a hollow needle (aspirator) into the testis through the stretched scrotal skin. It doesn’t matter where the needle is inserted because there are enough sperm everywhere
· Testis tissue is removed using the needle and then placed into test tubes or petri dishes containing culture medium. The TESA procedure can be repeated on the same testis or the other one until enough sperm has been obtained. The sperm is then processed by the lab
· TESA recovery takes about one day and there are very low risks of complications and side effects such as bleeding and infection
TESA Procedure with Non-Obstructive Azoospermia
· It is sometimes difficult to obtain sperm from men with this condition because they have such low rates of sperm production. Their sperm production can often be inconsistent or patchy
· Rather than undergoing the TESA procedure, fertility specialists often recommend that men with non-obstructive azoospermia consider other sperm aspiration procedures such as microdissection TESE