PESA & TESE, Epididymis
TESE (Testicular Sperm Extraction) & PESA (Percutaneous Epididymal Sperm Aspiration)
Men diagnosed with azoospermia often undergo minor surgical procedures to retrieve sperm directly from the epididymis or testes. For men with blockages in their reproductive systems, PESA (Percutaneous Epididymal Sperm Aspiration) and TESE (Testicular Sperm Extraction) provide effective options for collecting viable sperm samples.
PESA and TESE are commonly used to retrieve healthy, mature sperm in cases of male infertility. After retrieval, the sperm are combined with eggs in a controlled environment (such as a petri dish) for fertilization and then implanted into the woman’s uterus to support a healthy pregnancy.
Keep reading to learn more about PESA, TESE, and the critical role of the epididymis in male fertility. Want to understand which procedure might be right for you? Schedule a consultation to learn more about male infertility treatments.
Understanding Azoospermia and Epididymis-Related Causes
Azoospermia is a condition related to male infertility in which the testicles are unable to produce sufficient sperm cells. It can have both obstructive and non-obstructive causes. Obstructive azoospermia occurs when part of the reproductive tract is blocked, preventing sperm cells from passing into the ejaculate.
Non-obstructive azoospermia, on the other hand, results from insufficient sperm production or when the testicles stop producing sperm entirely.
Sperm is produced in the testicles and then travels to the epididymis, a coiled tube where it is stored, matures, and is prepared for ejaculation before passing through the vas deferens and urethra. Obstructive azoospermia happens when sperm production occurs in the testis, but a blockage in the epididymis or vas deferens prevents sperm from entering the ejaculate.
Percutaneous Epididymal Sperm Aspiration (PESA)
Men with obstructive azoospermia may undergo PESA, a procedure that collects sperm directly from the epididymis. This approach is particularly effective for patients with blockages in the vas deferens or epididymis, as well as those with retrograde ejaculation a condition where semen flows backward into the bladder rather than being released through the urethra.
PESA has an average success rate of 83% for sperm retrieval. For patients with congenital bilateral absence of the vas deferens (CBAVD), the success rate is even higher, at 96.8%. The procedure can be repeated until your healthcare provider collects enough sperm for lab testing or Intra Cytoplasmic Sperm Injection (ICSI).
Testicular Sperm Extraction (TESE)
Testicular Sperm Extraction, or TESE, is recommended for men with a very low or zero sperm count in ejaculation. The procedure involves extracting sperm from your testicles to determine the presence of healthy sperm production in your testis.
If no sperm is found in the epididymis, your healthcare provider will schedule TESE to retrieve healthy and motile sperm directly from the testicles. The semen sample is then sent to the lab to detect the sperm count, quality of the sperm, and the problem in your reproductive tract. TESE is widely used in men with a congenital absence or those with no sperm in the epididymis.
TESE is used in men diagnosed with obstructive Azoospermia. Micro TESE is another effective testing procedure for those with nonobstructive Azoospermia and other fertility-related issues in men.
Comparison between PESA and TESE
Both PESA and TESE are performed in men with azoospermia-related infertility. However, these are different procedures and involve the extraction of sperm from different parts. As mentioned previously, PESA is a minimally invasive procedure that requires sperm retrieval from your epididymis.
TESE, on the other hand, is reserved for men who do not have enough sperm reserve in the epididymis. In such cases, the sperm sample is extracted from the testicles. MicroTese is scheduled the same day or a day after the egg retrieval.
Although the sperm collected in the procedure is far less than the sperm produced in ejaculation, the procedure is considered effective in azoospermic men.
Procedure and Outcomes: A Focus on Epididymis Relevance
PESA
PESA is a minimally invasive procedure performed under local anesthesia, mostly in an outpatient setting. A fine needle is inserted into your epididymis to retrieve the fluid. Your healthcare provider will extract healthy sperm from this liquid and store it.
TESE
TESE can be performed under local anesthesia or general anesthesia, depending on where you take the test. If PESA has failed or there’s no sperm trace found in your semen, the doctor will schedule TESE to collect sperm from the testicles. A thin needle is inserted into your testis to collect sperm samples.
Benefits and Considerations
PESA and TESE help collect healthy sperm for infertility screening. These are viable options for men who can’t release sperm in their ejaculation due to Azoospermia or other causes of obstruction in their reproductive system.
These sperm cells are stored for future IVF cycles. The procedures are mostly scheduled with the egg retrieval process, as it helps fertilize women’s eggs. Sperm and eggs collected are kept in the petri dish for fertilization, and the resulting embryo is transferred into the woman’s uterus. Simply put, parents who can’t conceive naturally due to man’s infertility can consider PESA or TESE.
Although the procedures are considered safe, they involve the insertion of the needle into your epididymis and testis. This presents the risk of hematoma. Some rare side effects of the procedure involve heavy bleeding, permanent damage to your epididymis, and the inability to collect sperm from the testis or epididymis.
Make sure you discuss the risk factors with your doctor before proceeding with these procedures. Your healthcare provider will consider your age, prior fertility tests, and conception goals to recommend the most suitable sperm extraction procedure.
Conclusion
Genetic factors, infection or inflammation of the reproductive organs, or a previous surgery cause testicular problems in men. TESE and PESA can help detect the cause of infertility and the sperm count in men. The procedures are also used to determine the sperm quality in the semen.
Men with congenital absence, i.e., missing vas deferens from birth, can undergo TESE to retrieve sperm directly from the testicles. Talk to your healthcare provider to learn more about sperm extraction procedures, their safety score, risk factors, and whether you are a good candidate.
