PESA, TESA, TESE, MESA and micro-TESE
The reasons for infertility in men are many – low sperm count and zero sperm count are the most common conditions. But there are procedures that offer hope to men to become biological fathers. Surgical extraction of sperms from them helps with intracytoplasmic sperm injection (ICSI), that can be done along with IVF treatment, resulting in the joy of parenthood.
PESA, TESA, TESE, MESA and micro-TESE are the surgical methods deployed to retrieve spermatozoa from the epididymis or testis of men with azoospermia, the condition where there’s no sperm in the ejaculate. First, epididymal fluid or testicular tissue is collected and washed in laboratory techniques to remove contaminants, cellular debris, harmful microorganisms and red blood cells, and finally be used for intracytoplasmic sperm injection. Sometimes, the washed sperms are cryopreserved for multiple cycles of IVF in future, if required.
Microsurgical Epididymal Sperm Aspiration or MESA is a relatively painless and minimally invasive procedure performed under local anaesthesia to extract sperm directly from the epididymal tubules. Through a tiny incision, the epididymal tubules are opened and sperm contained within is extracted and immediately checked under a microscope to ascertain quality.
PESA or Percutaneous Epididymal Sperm Aspiration is the procedure in which a needle is inserted into the epididymis to retrieve spermatozoa, under mild sedation. This is done in case the epididymis is enlarged after a vasectomy or in other conditions where there is a blockage. The procedure is relatively painless as there’s no incision.
Similar to PESA, Testicular Sperm Aspiration or TESA is the procedure done under local anaesthesia where a needle is inserted into the testis to retrieve spermatozoa for use in an ICSI procedure. The sample collected is immediately examined under a microscope to find healthy sperm. The procedure is relatively painless and do not require an incision in the scrotum or a general anaesthetic.
TESE or Testicular Sperm Extraction refers to the surgical removal of testicular tissue to collect sperm. It’s usually done to diagnose the cause of azoospermia. The extracted sperm can be used fresh or frozen according to the treatment.
Microdissection Testicular Sperm Extraction or Micro-TEST is a microsurgical procedure used to dissect the seminiferous tubules to identify areas of sperm production and extract spermatozoa. The amount of tissue required for sperm extraction is much smaller in the procedure. Other than a better chance of finding sperm in a patient with non-obstructive azoospermia, the advantage is that there’s less damage to blood vessels.