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You are here : Home / Fertility / TESE
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TESE


PESA / TESE

These procedures are offered to couples in cases where the male has no sperm present in the ejaculate. They are used in conjunction with an ICSI procedure. (For more information please see the ICSI section).

In some semen samples there may be no sperm present in the ejaculate. There can be a variety of reasons for an absence of sperm known as Azoospermia.
  • There may be a blockage of the tubules that carry the sperm from the testicles to the penis.
  • The passages themselves may not have developed so sperm cannot be transported. This is known as absence of the vas deferens. If the latter is diagnosed then genetic counselling may be offered as there can be a high risk of males with this diagnosis who are identified as carriers of the cystic fibrosis gene.
  • In some cases sperm may be produced but in low numbers, and therefore not seen in the semen sample.
  • The male may have had a vasectomy performed which means that the passages that carry the sperm have been severed.

PESAPESA- Percutaneous Epididymal Sperm Aspiration

This procedure may be performed under GA or local anaesthetic with sedation. A fine needle is passed into the epididymis to extract fluid. This is then checked in the laboratory by the embryologist for sperm.

TESE- Testicular Sperm Extraction

This procedure may be performed under GA or local anaesthetic with sedation. A small sample of testicular tissue is extracted from the testes. This can be achieved by either a fine needle being inserted into the testes or a small incision being made.

Sperm that is extracted by the above procedures will then be used in conjunction with an ICSI cycle. ICSI involves a selected single sperm injected directly into a mature egg. The eggs will then be placed in an incubator and checked the following day for fertilisation. An Embryo Transfer is normally scheduled 2-3 days following egg collection.

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ICSI

Effects of ICSI

ICSI is still a relatively new procedure therefore the research on the effects that it may have on children born is still limited. It is possible that male children born may inherit the same type of infertility that the male partner presented if the sperm production was affected by a chromosome abnormality. Genetic counselling may be offered in such cases.




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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