TESA / PESA

TESA / PESA

Introduction

Testicular Sperm Aspiration (TESA) and Percutaneous Epididymal Sperm Aspiration (PESA) stand at the forefront of male reproductive interventions, offering hope and possibilities to couples facing male infertility challenges. These procedures represent advanced techniques designed to retrieve sperm directly from the testes (TESA) or the epididymis (PESA) when natural sperm production or transport is compromised. In the intricate landscape of assisted reproductive technologies, TESA and PESA play pivotal roles, providing an avenue for men with obstructive or non-obstructive infertility issues to contribute genetic material for in vitro fertilization (IVF) and ICSI.

The Tesa Procedure:

Testicular Sperm Aspiration (TESA) Procedure in Detail:

• Patient Evaluation: Before TESA, the male partner undergoes a thorough evaluation, including a physical examination, semen analysis, and hormonal tests to assess the nature and cause of infertility.
• Choosing TESA: TESA is chosen when there is a need to retrieve sperm directly from the testicles due to issues with sperm production or transport. It is commonly employed in cases of non-obstructive azoospermia or when obstructive azoospermia is present, and other methods like PESA are not suitable.
• Anesthesia or Local Anesthetic: TESA is typically performed under local anesthesia or conscious sedation to ensure patient comfort during the procedure. The choice of anesthesia depends on the patient’s preference and the complexity of the case.
• Needle Aspiration: A fine needle or a small, thin tube is carefully inserted into the testicular tissue. The needle is used to aspirate a small amount of tissue containing sperm. The aspiration is done meticulously to minimize discomfort and potential damage to the testicular tissue.
• Tissue Collection: The aspirated tissue, which contains sperm, is then carefully removed. Multiple aspirations may be performed in different areas of the testicles to increase the chances of retrieving an adequate number of sperm.
• Sperm Processing: The collected tissue is transported to the laboratory, where the sperm are isolated and processed for use in assisted reproductive technologies (ART). This processing may involve washing, concentration, and preparation for use in subsequent procedures like in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
• IVF or ICSI: The processed sperm is used for fertilization. In IVF, the sperm and eggs are combined in a culture dish to facilitate fertilization, while in ICSI, a single sperm is directly injected into an egg. The choice between IVF and ICSI depends on various factors, including the quality of the sperm.
• Embryo Culture: Fertilized eggs grow as a embryos in a lab within  controlled environment. The embryonic development is monitored for several days to assess the quality and viability of the embryos.
• Embryo Transfer: Once the embryos reach an optimal stage of development, one or more embryos are selected for transfer into the uterus. This procedure done through the cervix by using a thin catheter.
• Pregnancy Monitoring: Following embryo transfer, the woman undergoes regular monitoring to assess the success of the procedure. Pregnancy is confirmed through the detection of beta-hCG, and subsequent ultrasounds are used to monitor fetal development.

The Pesa Procedure:

Percutaneous Epididymal Sperm Aspiration (PESA) Procedure in Detail:

• Patient Evaluation: Before PESA, the male partner undergoes a comprehensive evaluation, including a physical examination, semen analysis, and hormonal tests to assess the nature and cause of infertility.
• Choosing TESA: PESA is chosen when there is a need to retrieve sperm directly from the epididymis due to issues with sperm transport. It is commonly employed in cases of obstructive azoospermia, where sperm production is normal but there is a blockage preventing sperm from reaching the semen.
• Anesthesia or Local Anesthetic: PESA is typically performed under local anesthesia or conscious sedation to ensure patient comfort during the procedure. The choice of anesthesia depends on the patient’s preference and the complexity of the case.
• Epididymal Access: A thin needle is inserted through the scrotum into the epididymis, the structure that stores and transports sperm. The goal is to aspirate epididymal fluid, which contains sperm. The procedure requires precision to access the epididymis without causing damage.
• Fluid Aspiration: The needle is used to aspirate epididymal fluid, which is then collected for further processing. Multiple aspirations may be performed in different areas of the epididymis to increase the chances of retrieving an adequate number of sperm.
• Sperm Processing: The collected epididymal fluid is transported to the laboratory, where the sperm are isolated and processed for use in assisted reproductive technologies (ART). This processing may involve washing, concentration, and preparation for use in subsequent procedures like in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
• IVF or ICSI: The processed sperm is used for fertilization. In IVF, the sperm and eggs are combined in a culture dish to facilitate fertilization, while in ICSI, a single sperm is directly injected into an egg. The choice between IVF and ICSI depends on various factors, including the quality of the sperm.
• Embryo Culture: Fertilized eggs grow as a embryos in a lab within  controlled environment. The embryonic development is monitored for several days to assess the quality and viability of the embryos.
• Embryo Transfer: Once the embryos reach an optimal stage of development, one or more embryos are selected for transfer into the uterus. This procedure done through the cervix by using a thin catheter.
• Pregnancy Monitoring: Following embryo transfer, the woman undergoes regular monitoring to assess the success of the procedure. Pregnancy is confirmed through the detection of beta-hCG, and subsequent ultrasounds are used to monitor fetal development.

Benefits of Tesa/Pesa:

Benefits of TESA (Testicular Sperm Aspiration) and PESA (Percutaneous Epididymal Sperm Aspiration) Procedures:

• Overcoming Male Factor Infertility: TESA and PESA are valuable interventions for couples facing male factor infertility, providing a solution when natural sperm production or transport is compromised.
• Azoospermia Treatment: In cases of azoospermia (absence of sperm in the ejaculate), TESA and PESA offer a means to retrieve viable sperm directly from the testicles or epididymis, allowing for the possibility of biological parenthood.
• Obstructive Azoospermia Solution: PESA is particularly effective for obstructive azoospermia, where a blockage prevents sperm from reaching the semen. By directly aspirating sperm from the epididymis, PESA circumvents the obstruction.
• Sperm Retrieval for Assisted Reproductive Technologies (ART): TESA and PESA are integral to assisted reproductive technologies such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). They provide a source of viable sperm for fertilizing eggs in the laboratory.
• Increased Chances of Pregnancy: By retrieving sperm directly from the testicles or epididymis, TESA and PESA enhance the chances of achieving a successful pregnancy for couples facing male infertility challenges.
• Customized Fertility Treatment: TESA and PESA allow for a tailored and personalized approach to fertility treatment. The retrieved sperm can be used in conjunction with the female partner’s eggs in various ART procedures, adapting to the specific needs of each couple.
• Minimization of Surgical Risks: TESA and PESA are minimally invasive procedures, often performed under local anesthesia or conscious sedation. This minimizes the risks associated with more extensive surgical interventions.
• Opportunity for Biological Fatherhood: For men with non-obstructive azoospermia or other conditions impacting sperm production, TESA provides an opportunity for biological fatherhood by directly obtaining sperm from the testicles.
• Avoidance of Surgical Sperm Retrieval: TESA and PESA can be performed without the need for more invasive surgical sperm retrieval methods, such as testicular sperm extraction (TESE). This may be advantageous for certain patients.
• Useful in Cases of Failed Vasectomy Reversal: In cases where a vasectomy reversal has failed to restore sperm flow, PESA can be a viable alternative for obtaining sperm for use in assisted reproductive technologies.
• Reduced Emotional Stress: TESA and PESA offer a ray of hope to couples experiencing the emotional stress of infertility, providing a pathway for biological parenthood and potential success in fertility treatments.
• Potential for Cryopreservation: The retrieved sperm can be cryopreserved (frozen) for future use, allowing for flexibility in timing and multiple attempts at assisted reproduction without the need for repeat sperm retrieval.

Considerations of TESA/PESA

• Underlying Cause of Infertility: TESA and PESA are most effective in cases of male factor infertility where sperm production or transport is compromised. The underlying cause of infertility, whether obstructive or non-obstructive, influences the choice between TESA and PESA.
• Nature of Azoospermia: The type of azoospermia (obstructive or non-obstructive) influences the choice of procedure. PESA is particularly suitable for obstructive azoospermia, whereas TESA may be more appropriate for non-obstructive azoospermia.
• Quality and Quantity of Retrieved Sperm: The success of TESA and PESA depends on the quality and quantity of the retrieved sperm. The ability to obtain an adequate number of viable sperm for fertilization impacts the overall success of assisted reproductive technologies (ART).
• Patient’s Age and Fertility Factors: The age of both partners and other fertility factors contribute to the overall success of fertility treatments. TESA and PESA may be more challenging in cases where additional fertility factors are present.
• Previous Treatment History: The success of TESA and PESA may be influenced by the patient’s previous treatment history, including any prior surgeries, treatments, or fertility interventions.
• Surgical Expertise: The expertise of the medical team performing the procedure is crucial. Skilled and experienced clinicians enhance the likelihood of successful sperm retrieval and minimize potential complications.
• Potential Need for Multiple Procedures: In some cases, multiple TESA or PESA procedures may be required to obtain a sufficient number of sperm for use in assisted reproductive technologies. This consideration impacts the overall treatment plan.

Success Rates:

• Varied Success Rates: Success rates for TESA and PESA can vary based on factors such as the underlying cause of infertility, the expertise of the medical team, and the patient’s individual circumstances.
• Higher Success in Obstructive Azoospermia: PESA tends to have higher success rates in cases of obstructive azoospermia, where sperm production is normal, but there is a blockage preventing sperm from reaching the semen.
• Lower Success in Non-Obstructive Azoospermia: TESA may have relatively lower success rates in cases of non-obstructive azoospermia, where sperm production is impaired. The success depends on the severity of the condition and the presence of viable sperm.
• Integration with ART Procedures: Success rates are also influenced by how well the retrieved sperm integrates with subsequent assisted reproductive technologies (ART) such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
• Age and Female Partner’s Fertility: The age of both partners and the fertility status of the female partner contribute to overall success. Advanced maternal age or fertility issues on the female side may affect the chances of a successful pregnancy.
• Monitoring and Adjustments: Continuous monitoring and adjustments to the treatment plan based on individual responses can contribute to improved success rates.
• Patient-Specific Factors: Each patient’s unique factors, including overall health, hormonal status, and response to previous treatments, can influence the success of TESA and PESA.
• Cryopreservation for Future Use: The ability to successfully cryopreserve (freeze) the retrieved sperm for future use is an additional factor that impacts the overall success and flexibility of the procedures.

Conclusion:

In conclusion, Testicular Sperm Aspiration (TESA) and Percutaneous Epididymal Sperm Aspiration (PESA) stand as pivotal interventions in the landscape of male factor infertility, offering hope and possibilities to couples striving to overcome challenges in natural sperm production or transport. These minimally invasive procedures provide a pathway to biological parenthood by directly retrieving sperm from the testicles or epididymis. The success of TESA and PESA is nuanced, influenced by factors such as the underlying cause of infertility, patient-specific considerations, and the integration of retrieved sperm with advanced assisted reproductive technologies. As integral components of fertility treatments, TESA and PESA exemplify the convergence of medical expertise, technological advancements, and the profound desire of individuals and couples to embark on the transformative journey toward building their families. With careful consideration and a collaborative approach between patients and their medical teams, TESA and PESA contribute to the realization of parenthood dreams, underscoring the remarkable possibilities within the realm of reproductive medicine.