TESA - PESA - Prosedürler (Azospermıa)
What are azoospermia and PESA/TESA/TESE?
Azoospermia is a condition where there is no sperm at all in a man’s ejaculated semen and effects %15 of men suffering from infertility. In order to make this diagnosis, at least 2 sperm samples must be examined by centrifugation. In cases seen as azoospermia on direct examination, even sporadic sperm can be found in the sediment after centrifugation and microinjection can be performed using these. Therefore, unnecessary Testicular Sperm Extraction (TESE) operation is not performed. In the presence of azoospermia, hormone tests and chromosomal analysis of the man should be done. The rate of chromosome defects in this group is 15%. The most common is Klinefelter Syndrome.
Sperm production and delivery involves a system of tubes within the male reproductive system. Sperm are initially produced in the testis in fine tubes called seminiferous tubules. In each testis these tubules are connected to a larger coiled tube called the epididymis in which sperm are held for a short while after production. The epididymis is in turn connected to the vas deferens which lead to the urethra. Sperm must move through this system in order to be deposited in the semen during ejaculation.
Azoospermia can be caused by an abnormality or blockage in the epididymis or the vas deferens. This is referred to as obstructive azoospermia. In these cases, sperm are being produced in the testes, they just can’t get out.
Sometimes however, sperm production in the seminiferous tubules does not occur at all or is happening at such a low level that sperm are not detectable in the ejaculate. This is referred to as non-obstructive azoospermia.
Using surgical procedures to try and extract sperm from the epididymis (PESA) or to dissect it out of tubules from the testis (TESA) can be an effective way of diagnosing what is causing azoospermia.
More importantly though, these procedures can also be effective ways of isolating sperm for use in treatment to try to achieve a pregnancy. Even in non-obstructive azoospermia, as long as some sperm production is occurring, PESA/ TESA can still be an effective way of retrieving sperm for use in treatment.
Who can benefit from PESA/TESA?
The possible causes of lack of sperm in your ejaculate include:
- Testicular problems resulting in poor sperm production. These can be caused by various factors such as genetic issues, previous infection (e.g. mumps), maldescended testes.
- An irreversible obstruction of the genital tract (possibly caused by a previous infection, trauma or surgery)
- Congenital absence (absence from birth) of the vas deferens, which is common in carriers of cystic fibrosis
- A previous vasectomy or an unsuccessful vasectomy reversal.
PESA Percutaneous Epididymal Sperm Aspiration: A very small needle is used to aspirate fluid from the epididymis after giving local anesthesia. The fluid is viewed under a microscope to find sperm to be used for ICSI.
TESA Testicular Sperm Aspiration: A punch biopsy with local anesthesia is used to take a small sample of tissue from the testicle. The tissue is minced and searched for sperm to be used with ICSI.
TESE Testicular Sperm Extraction: Under general anesthesia, the testicle is surgically opened to extract a larger sample of tissue and gather sperm. The tissue is minced and searched for sperm to be used with ICSI.
AFTER THE PROCEDURE: You will recover after sedation anesthesia. When you wake up approximately after 15 - 45 min, you will be discharged home.
- You may have mild pain and tenderness in your scrotum for a few days. You will get a prescription for pain medication. Take it as directed by your doctor.
- You may also have mild bruising (a “black and blue” appearance) on your scrotum. Your penis and scrotum may be swollen. This is normal and should go away over the next week
- You can shower 3 days after your procedure. Don’t soak in a pool, bathtub, or hot tub for 2 weeks after your procedure.
- You can resume your normal activity 3 days after your procedure. If you develop new pain, or your pain gets worse, as you do more activities, limit your activity until your pain gets better.
- Don’t drive while you’re taking pain medication. The pain medication can make you drowsy.
- Don’t lift any objects heavier than 10 pounds (4.5 kilograms) for at least 2 weeks after your procedure.
- You can resume sexual activity 1 week after your procedure.
CALL US IF YOU HAVE:
- A temperature of 38.3°C (101°F) or higher
- Pain that doesn’t go away with pain medication chills
- Swelling in your scrotum or penis that’s getting worse
- Drainage or pus coming from your incision
* On the same day, the extract will be explored for any viable sperm and will be frozen.