Treatments

Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Aspiration (TESA)

Azoospermia, the condition characterized by a complete lack of sperm in the semen, is the most severe form of male infertility. In the past, azoospermia was untreatable, but today, there are solutions available for many men.

Sperm Retrieval Methods: PESA and TESA

There are two primary methods for sperm retrieval: Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Aspiration (TESA). PESA involves collecting sperm from the epididymis within the scrotum using a syringe and a fine needle. This method is typically used when there is no sperm in the ejaculate due to blockages in the sperm passages. These blockages may occur due to reasons such as vasectomy reversal, damage to the vas deferens from infection, or bilateral congenital absence of the vas deferens.

Testicular Sperm Aspiration: TESE and microTESE

The microTESE testicular biopsy offers a solution to the problem of azoospermia, which is a significant cause of infertility. Microsurgical sperm retrieval is particularly effective for cases of azoospermia.

Challenges of the Traditional TESE Method

While drug or hormonal stimulation of the testes may occasionally cause the temporary appearance of spermatozoa in the ejaculate, the primary solution for most men involves retrieving sperm through a testicular biopsy, known as Testicular Sperm Extraction (TESE). The traditional TESE method, although widely used, presents certain challenges.

The main issue with the TESE technique is its random nature. A small incision is made in the scrotum, and small, random incisions are performed on the testicle to collect material from the seminiferous tubules. However, this approach may miss areas of the testicle where sperm are present because the biopsy samples are taken randomly, and the sperm might be located in an adjacent area that was not sampled.

The Importance of microTESE in Testicular Biopsy

In cases of azoospermia, the testicular damage is often severe but not uniform throughout the testicle. Some areas within a damaged testicle may still be normal and capable of producing sperm. It is essential to identify and target these healthy areas to find sperm.

The correct technique for locating sperm in an azoospermic man is the microscope-guided biopsy, known as microTESE. During this procedure, the doctor uses a specialized microscope to identify healthy areas in the testicle where sperm may be found.

The microTESE Procedure

During microTESE, the surgeon meticulously examines the testicle, ensuring the preservation of its arteries while searching for healthy tissue. Once a healthy area is located, a sample is carefully extracted.

In the operating room, an embryologist uses a microscope to analyze the sample to determine if sperm are present. The process is repeated until the entire testicle is thoroughly examined. This technique requires specialized skills and experience.

Advantages of the microTESE Method

Using a microscope during a microTESE procedure significantly increases the chances of finding sperm. According to studies, the success rate of finding sperm using microTESE in azoospermic patients is around 30%.