What are the types of surgical extraction available?
These are different types of sperm retrieval including – Percutaneous Epididymal Sperm Aspiration (PESA), Testicular Sperm Aspiration (TESA), Testicular Sperm Extraction (TESE), Micro epididymal Sperm Aspiration (MESA) and Microdissection TESE (micro TESE). The process of sperm extraction and implantation involves three steps – evaluation, extraction, and implantation. The evaluation is to determine the cause of the infertility and arrive at the appropriate procedure for extraction of the sperm. Extraction involves the actual retrieval of the sperm, while insemination takes place either via the IUI or IVF modes.
Testicular sperm aspiration (TESA)
TESA is a procedure prescribed for men who are participating in an IVF/ICSI cycle. Performed under local anaesthesia, this involves using a needle that is inserted into the testicle while a tissue sample/sperm are aspirated. This is usually for men suffering from non-obstructive azoospermia.
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA involves the use of needle and syringe technique as for a needle biopsy and is used for men who are participating in an IVF/ICSI cycle. This procedure is useful for those with obstructive azoospermia caused by a previous vasectomy or infection. The procedure is performed under local anaesthesia.
Testicular sperm extraction (TESE)
In case of TESE the testicle is surgically opened to extract a larger sample of tissue and retrieve the sperm. Sperm extracted during this procedure is usually cryopreserved for future IVF/ICSI.
Micro epididymal Sperm Aspiration (MESA)
Micro epididymal Sperm Aspiration is a procedure prescribed for men with vasal or epididymal obstruction. The sperm extracted are largely cryopreserved for future IVF/ICSI. This procedure allows for an extensive collection of mature sperm when compared to aspiration techniques. Thus, it is now a more preferred method of retrieval for men with congenital bilateral absence of the vas deferens.
Microdissection TESE (micro TESE)
MicroTESE has replaced TESE as the preferred form of sperm retrieval for men with no sperm in their ejaculate. The procedure is performed under general anaesthesia and has improved sperm retrieval rate. This is considered a safer procedure as less testicular tissue is removed and patients usually choose to cryopreserve their sperm for future IVF/ICSI.