PESA/TESA

What is PESA?

PESA (Percutaneous Epididymal Sperm Aspiration) is a minimally invasive procedure designed to retrieve sperm directly from the epididymis, a small organ behind the testicles where sperm mature and are stored. It is primarily used for men with obstructive azoospermia, a condition where there is a blockage or absence of sperm in the ejaculate, preventing sperm from reaching the semen.

PESA is a highly effective technique in male infertility treatment, especially for men who have undergone vasectomy, have congenital absence of the vas deferens, or suffer from other blockages in the male reproductive tract. This procedure is often combined with ICSI (Intracytoplasmic Sperm Injection) or IVF (In Vitro Fertilization) to help couples conceive.

Why is PESA Necessary?

PESA is crucial for men with obstructive azoospermia, where sperm production is normal, but a blockage in the sperm ducts prevents sperm from entering the ejaculate. The main indications for PESA include:

1. Vasectomy: Men who have previously undergone a vasectomy and wish to reverse their infertility.
2. Congenital Absence of the Vas Deferens: Men born with a blockage in the vas deferens, which prevents sperm from reaching the ejaculate.
3. Epididymal Blockages: Men with blockages in the epididymis, the structure where sperm are stored and matured.
4. Failed Sperm Collection: When other sperm collection methods, such as ejaculation, do not yield sperm for IVF/ICSI.
5. Male Factor Infertility: When male infertility is identified, and a blockage is suspected in the sperm transport system.

How is PESA Performed?

The PESA procedure is relatively quick, minimally invasive, and generally performed under local anesthesia. Here is an overview of the process:

1. Local Anesthesia: The procedure begins with the administration of local anesthesia to numb the scrotum, ensuring comfort for the patient during the procedure.
2. Needle Insertion: A thin, fine needle is inserted through the scrotum into the epididymis to aspirate sperm.
3. Sperm Aspiration: The needle draws out sperm directly from the epididymis. The collected sperm is examined under a microscope to assess its quality.
4. Analysis: After collection, the sperm is processed and prepared for use in ART procedures such as ICSI or IVF.
5. Post-Procedure Care: The procedure typically takes 15 to 30 minutes, with minimal downtime. Most men can return to normal activities within a couple of days.

Benefits of PESA

• Minimally Invasive: PESA does not require an incision, making it a less invasive and more comfortable option compared to other sperm retrieval methods like TESE (Testicular Sperm Extraction).
• Quick Recovery: With no large incisions, the recovery time for PESA is short. Most men experience minimal pain or discomfort following the procedure.
• High Success Rate: PESA is highly effective for men with obstructive azoospermia, especially if sperm is present in the epididymis, ensuring a higher chance of sperm retrieval for ICSI or IVF.
• No Need for Testicular Surgery: Since PESA targets sperm from the epididymis rather than the testicle, it is a less invasive procedure with a lower risk of complications compared to testicular biopsies.
• Cost-Effective: Compared to other sperm retrieval methods like TESE, PESA is relatively cost-effective, offering a more affordable solution for sperm retrieval.

Risks and Considerations of PESA

While PESA is a minimally invasive procedure with a high success rate, there are some risks to be aware of:

• Infection: As with any medical procedure, there is a small risk of infection. However, proper care before and after the procedure can help reduce this risk.
• Bleeding: Minor bleeding may occur at the site of the needle insertion, but this is usually minimal and resolves on its own.
• Sperm Retrieval Success: Although PESA is highly successful in men with obstructive azoospermia, there may be cases where sperm is not found in the epididymis, which may necessitate alternative procedures like TESE.
• Discomfort: Mild pain, swelling, or bruising may occur after the procedure, but these side effects typically subside within a few days.