Percutaneous Epididymal Sperm Aspiration (also called as PESA) is a method for sperm retrieval in men with Obstructive Azoospermia that occurs due to blockage of vas deference. In this technique the sperms are extracted from epidydemis as compared to TESA, where sperms are extracted from testis.

What are the causes of Obstructive Azoospermia 

• Absence of vas deference due to birth defect caused by Genetic Factor 
• Blockages in Epididymis & ejaculatory duct due to infection & fibrosis
• Damage to vas deference due to surgery in nearby area like Hernia Repair or other surgery
• Infection in vas deference 
• Vasectomy ( operation done in male for family planning )
• Congenital absence of bilateral  vas deferences  ( CABD)  which occur in all cases with cystic fibrosis.  

When to use PESA vs TESA?

In TESA and TESE, sperms are directly extracted from testes. This is used when due to some blockage sperms are not able to move beyond testes. Its also used if the count of sperms is extremely low.

In PESA sperms are extracted from epididymis, where sperms are stored and matured. It is used when sperms are produced in testes and send to epididymis, but there is blockage in further organs.

Other infertility conditions where PESA is useful

 ♦ Obstructive Azoospermia – Sperms are produced but not able to move beyond epididymis 

 ♦ Asthanozoospermia – Reduced or absent sperm motility 

 ♦ Oligospermia – Low sperm concenteration in semen.

 ♦ Cryptozoospermia – Complete absence of sperms

 ♦ Necrozoospermia – Dead sperms in semen

 ♦ Retrograde Ejaculation – a condition where ejaculation go backward in urinary bladder instead of coming through urethra 

In all above cases sperm extraction is done for IVF or ICSI cycle. 

Some non-infertility conditions where PESA is useful

Testing of sample retrieved through PESA can be used for diagnosis of other diseases also.

 ♦ Varicocele  – shrinkage of testicles, may lead to male infertility.

 ♦ Hydrocele - swelling in testicles increasing pressure on testies)

 ♦ Orchitis ( inflammation in Testies )

 ♦ Testicular tottion due to injuries 

 ♦ Lumps in testies with possibility of testicular cancer

How is PESA sample used for Fertilization?

 ♦ PESA sample is used in IVF (In Vitro Fertilisation ) if sample contains good amount of healthy sperms. 

 ♦ Best results are with ICSI ( intracytoplasmic Sperm Injection ). Its used when sperm quality is really very poor and those can't fertilze the egg by themselves. 

Technique of PESA 

 PESA does not need surgery. Its just a needle insertion, hence only local anaesthesia is given. 

¨ A small needle is passed directly into the head of epididymis through the scrotal skin & fluid is aspirated. 

¨ Embryologist retrieve sperms from this fluid & stored safely. 

¨ Procedure is coordinated with their female partner‘s egg retrieval or ovulation.

¨ Fertilization is done using IVF or ICSI as soon as sperms and eggs both are available.

Can natural Fertilization or IUI be an option with PESA sample?

Usually PESA ( or any other sperm retrieval process) is used when sperms are absent, low or of poor quality. Hence those do not have enough strength to fertilize the egg naturally.  

IUI does stand chance, but very remote. 

However if these processes do not work, a second round of retrieval will be required, which may not provide a sperm sample fit for purpose.

IVF and ICSI are tried and tested method giving very high pregnancy rate.

What all tests are required before PESA?

Tests to be done can be classified into two sections:

 ♦ FSH hormone test – This is done to check the fertility level. Higher FSH makes testes non-productive leading to low/absent sperm count. Values between 1.5 -12.4 IU /ml indicate normal levels.

 ♦ Routine Tests – To check patient’s general fitness level. These include Routine blood tests HB, Blood sugar, thyroid function tests & tests for HIV & HBS Ag are done alogwith FSH test. 

The objective of these tests is to ensure that any desease from parents should not be passed to baby.

Benefits of PESA

 ♦ PESA involves no complex surgical process

 ♦ Minimum pain & discomfort 

 ♦ Risks of complications are very limited 

 ♦ No open surgery 

 ♦ Less time consuming ( hardly 10 min are required for procedure)

 ♦ Can be repeated 2-4 times to get adequate number of sperms 

Risks involved in procedure 

PESA is consider as a very safe & mild surgery for sperm reteival but there can be some possible side effects like 

 ♦ Haematoma – bleeding outside of blood vessels.

 ♦ Infection 

 ♦ Severe pain 

 ♦ Swelling & discouration in the scrotum 

Conclusion

PESA is a one of the latest sperm retrieval technique for male infertility due to poor quality, quantity or motility of sperms in semen. This procedure is less painful & less time consuming with no surgery required. 

PESA sperms give best results when IVF or ICSI are used for fertilization. 

Akruti IVF Hospital Dombivli is having expert team of clinicians & embryologists not just for PESA, but also for and other male infertility teatment. 

Based on our Andrology analysis, we suggest and provide the best treatment out of TESA/TESE, Micro-TESA.