Percutaneous Epididymal Sperm Aspiration

Percutaneous epididymal sperm aspiration (PESA) is a technique used to determine sperm count in cases of possible obstruction of the vas deferens.

Percutaneous Epididymal Sperm Aspiration (PESA)

Percutaneous epididymal sperm aspiration or PESA is a short procedure performed for men with obstructive azoospermia who are having their sperm retrieved for IVF or ICSI. The obstructive azoospermia is caused by either a prior vasectomy, infection, or blockage in the vas deferens. It is done with local anaesthesia in the operating room and is coordinated with their female partner's egg retrieval.

The use of non-ejaculated sperm coupled with intracytoplasmic sperm injection has become a globally established procedure for couples with azoospermic male partners who wish to have biological offspring. Surgical methods have been developed to retrieve spermatozoa from the epididymis and the testes of such patients.

Obstructive azoospermia is associated with the inability to detect spermatozoa in the ejaculate and post-ejaculate urine after centrifugation due to the bilateral obstruction of the seminal ducts. In such cases PESA is done. It does not need surgery but involves needle insertion and hence only local anaesthesia is needed.

Benefits of PESA

  • Involves no complex surgical process
  • Minimum pain & discomfort
  • Risks of complications are very limited
  • No open surgery
  • Less time consuming
  • Can be repeated 2-4 times to get an adequate number of sperms

How is it done?

PESA is an outpatient procedure which takes approximately 20-30 minutes. Firstly, local anaesthesia is administered to numb any pain that might occur during the entire process. The surgeon then inserts a fine needle through the scrotal skin and directly into the head of the epididymis, present in the upper area of the testes. Suction is then gently applied to aspirate fluid. The aspirated fluid is studied under a microscope for the presence of viable sperm. Sperm from this fluid is retrieved, and it can be frozen for future fertility treatments or used in an ICSI-IVF cycle. In case adequate sperm is not retrieved through PESA, the surgeon will recommend more advanced retrieval techniques. The procedure is coordinated with their female partner's egg retrieval or ovulation

Risks Involved

PESA is considered as a very safe & mild surgery for sperm retrieval but there can be some possible side effects such as

  • Haematoma - bleeding outside of blood vessels
  • Infection
  • Severe pain
  • Swelling & discoloration in the scrotum

Many recent reports have established PESA as a viable minimally invasive alternative to open surgeries. The number of sperm retrieved through PESA is usually very low compared to the number present in an ejaculate and so the sperm usually needs to be used in combination with ICSI. Surgically retrieved samples are rarely suitable for use in intrauterine insemination. Given the short operative times, minimal invasiveness, and high success rates, PESA is the sperm extraction procedure of choice for obstructive azoospermia .