Testicular Sperm Aspiration

Testicular Sperm Aspiration is performed on those male patients who have azoospermia (no sperm) to discharge. Under this system, the sperm will be straightforwardly recovered from the testis or epididymis

Testicular Sperm Aspiration (TESA)

Testicular Sperm Aspiration (TESA) is a procedure performed for men who are having their sperm retrieved for IVF or ICSI. Sperm retrieval is done when pregnancy is the goal but not possible without help. It is for men who have little or no sperm in the semen or men who aren't able to ejaculate. In these cases, sperm can be collected from other parts of the reproductive tract. TESA is done with local anaesthesia and is coordinated with their female partner's egg retrieval. A needle is inserted into the testicle and the sperm is aspirated.

TESA is a simple procedure used to obtain sperm in men with obstructive azoospermia. Men with this condition produce sperm at a normal rate, but a blockage prevents the sperm from reaching the semen. It commonly occurs in men who have had a vasectomy, who are missing the vas deferens or other functional abnormalities.

How is it done?

The surgery is minimally invasive and can be done in the doctor's office. First, a local anaesthesia is used to numb the testicles and the skin around them. A larger needle is then inserted into the testicle and tubules, and the sperm are suctioned out or aspirated through a syringe. Stitches are not needed for this procedure since no incisions are made during the process. Sometimes, TESA involves the retrieving of a small number of the seminiferous tubules themselves. The tubules are then dissected in the laboratory and the contents searched for the presence of sperm.

Unlike traditional open testicular biopsy or surgery, TESA saves time and cost for the patient. The procedure takes approximately 20 to 30 minutes, and recovery also is shorter and significantly less painful. The number of sperm retrieved through TESA is usually very low compared to the number present in an ejaculate, so the sperm usually need to be used in combination with ICSI. Surgically retrieved samples are not suitable for use in intrauterine insemination (IUI).

TESE and MicroTESE

If sperm cannot be obtained using the TESA technique, testicular sperm extraction (TESE) is the next step in the treatment. TESE is a simple surgery that also removes testicular tissue to find sperm in men. It can be performed at the doctor's office under local anaesthesia much like TESA. This surgery cannot be used on men with non-obstructive azoospermia because it is not able to sample all the areas of the testicle to find rare areas that are producing sperm. TESE involves making a small incision in the testis and examining the tubules for the presence of sperm. Patients usually cryopreserve sperm during this procedure for future IVF/ICSI.

TESA may be less effective for patients with sperm production problems and non-obstructive azoospermia. In such situations, microdissection TESE or microTESE may be recommended. Microsurgical testicular sperm extraction (microTESE) is a surgical procedure used to retrieve sperm from the seminiferous tubules of a male's testes. MicroTESE is performed in the operating room with general anaesthesia, and under the operating microscope. It is carefully coordinated with the female partner's egg retrieval, and is performed the day before egg retrieval. This allows for each partner to be there for the other's procedure. MicroTESE has significantly improved sperm retrieval rates in azoospermic men, and is a safer procedure since less testicular tissue is removed. In fact, doctors are able to find sperm approximately 60 percent of the time during microTESE procedures.

As always, there are risks associated with these procedures, which may include:

  • Pain and bleeding
  • Infection
  • Failure in finding sperm
  • Need for future procedures
  • Testicular injury or loss (although these are rare)