Testicular Sperm Extraction TESA

Introduction – Testicular Sperm Extraction TESA

Azoospermia is the medical condition of a male not having any measurable level of sperm in his semen. It is associated with very low levels of fertility or even sterility, but many forms are amenable to medical treatment. A number of surgical sperm retrieval or recovery methods have been devised to recover sperm from the male reproductive tract. Testicular sperm extraction (TESE) or also known to be testicular sperm aspiration (TESA) is one of the surgical sperm harvesting techniques used for retrieving sperm in patients with azoospermia.

In men with obstructive azoospermia (because of duct blockage or absence of the vas deferens duct), sperm are usually recovered from the epididymis. A method called MESA, or microepididymal sperm aspiration is used, in which the scrotum is opened, and an operating microscope is used to identify the epididymal tubules which are distended with sperm. While this method is very successful, but a complex one, since it requires an operating microscope; and happens to be very expensive.


A very simple and easy method was developed later to recover sperm from the blocked epidiymis. Since surgeons could feel the turgid epididymis, swollen with sperm, they would blindly puncture the epididymis using a simple butterfly needle – a technique which was very similar to drawing blood from a blood vessel. This simple technique is called PESA (percutaneous epididymal sperm aspiration), in which the sperm is sucked out from the epididymis by puncturing it with a fine needle. This method is as effective as microsurgery to retrieve epididymal sperm; is much easier for both the patient and the doctor; and much cheaper as well, since the infertility specialist can do it himself. It is also much less traumatic, since there is no need to cut the scrotum, with the result that there are no scars at all. This is why this is the preferred method of choice in most centers across the world.

For patients with obstructive azoopsermia in whom sperm cannot be found in the epididymis also, it is always possible to find sperm in the testis. The easiest way to retrieve this is through TESA, in which the testicular tissue is sucked out through a fine needle, under local anaesthesia. The testicular tissue is placed in culture media and sent to the lab, where it is processed. The sperm are liberated from within the seminiferous tubules (where they are produced) and are then dissected free from the surrounding testicular tissue.

Using sperm from the epididymis and testis for ICSI in order to treat patients with obstructive azoospermia is logical, and thus conceptually easy to understand. However, surprisingly, it is possible to find sperm even in patients who have testicular failure (non-obstructive azoospermia) – even in those men with very small testes. The reason for this is that defects in sperm production are “patchy”- they do not affect the entire testis uniformly

The sperm are liberated from within the seminiferous tubules (where they are produced) and are then dissected free from the surrounding testicular tissue.
Various methods have been devised to recover sperm from the testes. One of the methods uses an operating microscope to try to identify healthy testicular tissue, in the hope that the chances of finding testicular sperm improve. However, a much easier method has been developed where multiple needle biopsies are taken from both testes.

There are 2 options for doing a TESA – diagnostic; or therapeutic. In a diagnostic TESE, the surgeon performs multiple diagnostic biopsies to determine if sperm are being produced in the testes or not. If no sperm are found, the diagnosis of complete testicular failure is confirmed; and treatment options then include adoption or donor insemination, since there is no treatment at present for this condition. If sperm are found, then these testicular sperm can be cryopreserved and used for ICSI treatment in the future.

- Link of interest: Website American Fertility Association

This article is not medical advice nor a substitute to professional health advice. Always consult a doctor.


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