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You are here : Home / Fertility / TESA
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TESA

Testicular Sperm Aspiration/Extraction


What is a TESA/E?

The testicular sperm aspiration/extraction (TESA/E) involves the direct removal of sperm from the testicles, which can then be used in conjunction with Intracytoplasmic sperm injection (ICSI).

Obstructive azoospermia -Percutaneous testicular sperm retrieval

When dealing with obstructive azoospermia a simple percutaneous extraction of sperm is recommended. This procedure is performed under anesthesia (local or general) whereby a Tru Cut biopsy needle is utilized to extract a very small amount of testicular tissue. This tissue is then searched by a trained embryologist, who will then proceed with ICSI in order to fertilize your partner's eggs. The wound is closed with a few small absorbable stitches.

Nonobstructive Azoospermia - Microscopic testicular sperm retrieval

In clinical scenarios in which the testes are not producing adequate amounts of sperm (testicular atrophy, Y deletions, Kleinfelter's cases, post-chemotherapy/radiation) microsurgical testicular sperm extraction is performed. In this scenario, under general anesthesia an exhaustive search is performed under an operating microscope to search for testicular tubules that appear more developed and contain mature sperm. This procedure may take several hours and is done with direct input from the IVF embryology team. This procedure offers the most severe cases of male factor infertility the best chance of identifying sperm and proceeding with ICSI.

What are the indications for such a procedure?

There are many reasons why a TESA/E may need to be performed, but all involve an inability to produce an ejaculate with sperm sufficient for fertilization. Some examples are obstructive and non-obstructive azoospermia (NOA), CBAVD, and history of a vasectomy.

How do I prepare for the surgery?

You should not take anything containing aspirin 1 week prior to your surgery. You will be contacted 48 hours prior to the procedure with the exact date and time of the procedure. You will need to arrive on the 9th floor of 635 Madison Ave at the specified time. Do not eat or drink anything 8 hours prior to your scheduled surgery time - - this includes water. If there are medications you must take, you may do so with minimal water.

Will I be asleep?

Yes, general anesthesia is used.

When can I return to work?

We suggest that you allow 48 hours for recovery.

How long must I wait before I can return to normal sexual activity?

About 1 week before resuming sexual activity, or until you feel comfortable.

What if there is sperm leftover?

You will be given the option to sign a cryogenic freezing consent, which will give you the option to have any leftover sperm frozen for future use.

When are the stitches removed?

The stitches will dissolve; there is no need to have them removed.

What does the post-surgical care entail?

After the procedure, you will be groggy and wearing a jock strap for support. You must arrange for someone to pick you up and take you home directly. The doctor will have prescribed pain medication and antibiotics, which you should take as needed. It is recommended that you rest for at least the remainder of the day. Keep your pelvis elevated and apply ice packs. It is normal that the area be slightly discolored and tender. You may bathe, washing the area gently, after 48 hours. You should call to schedule a post-operative appointment 1-2 weeks after the procedure.

Be sure to notify the doctor immediately if there is discharge from the wound or you develop a fever.

Which Option is Best for Us? ??

Having so many options is great because "one size does not fit all." A comprehensive male fertility evaluation and a careful discussion with you and your partner will determine which option is the safest and the most efficient way to locate and retrieve sperm for you. Each option has its advantages and disadvantages:

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Option

Advantages

Disadvantages

MESA *

? Blood contamination

Lots of sperm back/? Retrieval rates

? Risk of hematoma

Best pregnancy rates

Requires microsurgery expertise

? Cost

General anesthesia

Requires scrotal exploration

? Post-operative discomfort

PESA


No microsurgery expertise required

Local or general anesthesia

Few instruments required

Fast/Repeatable

Minimal post-operative discomfort

? Cost

Feasiblility depends on anatomy

Less sperm back

Blood contamination

? Risk of hematoma

Damage to adjacent tissues

TESA

No microsurgery expertise required

Local or general anesthesia

Few instruments required

Fast/Repeatable

Minimal post-operative discomfort

? Cost

Less sperm back

Blood contamination

? Risk of hematoma

Risk of testicular damage/atrophy

TESE

No microsurgery expertise required

Local or general anesthesia

Few instruments required

Fast/Repeatable

If non-obstructive azoospermia,

Then less sperm back.

Risk of testicular damage/atrophy

Scrotal exploration required

Micro-TESE*

Few instruments required

Best for Non-Obstructive Azoospermia

Microsurgical expertise required.

General anesthesia

Not fast/Time consuming

Scrotal exploration required

??? Cost

?? Risk of testicular damage

?? Post-operative discomfort

Minimally repeatable

* Requires microsurgical expertise with fellowship-training preferable.




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