PESA/ TESA

Used In The Setting Of Post-Vasectomy Obstruction, CBAVD, Ejaculatory Duct Obstruction (EDO), And Unreconstructable Causes Of Obstructive Azoospermia.
1. Percutaneous Epididymal Sperm Aspiration (PESA)
2. Microsurgical Epididymal Sperm Aspiration (MESA)
3. Percutaneous Testicular Sperm Aspiration (TESA)

Sperm-retrieval techniques are procedures designed to collect sperm directly from the male reproductive system for use in assisted reproductive technologies (ART) or fertility preservation. These techniques are typically used when a man has difficulty ejaculating, has a blockage in the reproductive tract, or has a low sperm count. Here are some common sperm-retrieval techniques:

1. Ejaculation Techniques:
   • Masturbation: The most common method where the man masturbates to produce a semen sample, which is then used for various fertility procedures.
   • Electroejaculation (EEJ): Electrical stimulation is used to induce ejaculation in men who cannot ejaculate through masturbation due to neurological issues. It is usually performed under anesthesia.
2. Surgical Sperm Retrieval Techniques:
   • Testicular Sperm Aspiration (TESA): A needle is used to aspirate sperm directly from the testicle. This is a relatively simple procedure and can be performed in an office setting.
   • Percutaneous Epididymal Sperm Aspiration (PESA): Sperm is aspirated from the epididymis using a fine needle. This is often used when there is a blockage preventing the release of sperm during ejaculation.
   • Microsurgical Epididymal Sperm Aspiration (MESA): Under a microscope, a small incision is made in the scrotum to directly retrieve sperm from the epididymis. MESA is a more complex and precise technique.
   • Testicular Sperm Extraction (TESE): A small piece of testicular tissue is removed through a biopsy, and sperm are extracted from the tissue. This is often used when there are very few sperm in the ejaculate.
   • Microdissection Testicular Sperm Extraction (Micro-TESE): A more advanced form of TESE where the surgeon uses a microscope to identify and extract sperm-containing tubules, reducing the amount of testicular tissue removed.
3. Recovery of Sperm from Urine (Post-Ejaculatory Urine Sperm Retrieval):
   • For men with retrograde ejaculation (sperm entering the bladder instead of coming out through the penis during ejaculation), sperm can be retrieved from urine after ejaculation.
4. Sperm Retrieval Before Vasectomy:
   • Men who are planning to undergo a vasectomy may opt for sperm retrieval and cryopreservation before the procedure to preserve the option of having children in the future.

The choice of technique depends on the specific circumstances of the individual or couple, including the underlying cause of infertility and the preferences of the reproductive endocrinologist or urologist. These procedures are often performed in conjunction with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), where a single sperm is directly injected into an egg to facilitate fertilization.