Testicular Sperm Aspiration/Extraction (TESA/TESE) as the name suggests, is the procedure to collect sperms directly from the testes using one of the two methods – Aspiration (needle insertion) or Extraction (surgery). It is done in case of Azoospermia (no sperms in the ejaculate) hence there is a need to retrieve sperm directly from testis. 

It’s done in cases of Obstructive as well as Non-obstructive Azoospermia. 

Obstructive vs Non-Obstructive Azoospermia

Before we understand these terms, let’s get to know a little about Male reproductive System. In the normal case, sperms are produced in testes, stored and matured in epididymis, then through a tube called Vas deferens, transferred to urethra and ultimately move out of the male body.

In case of Obstructive Azoospermia, sperms are produced in testes but get blocked at one or more of the organs while on path to ejaculation. This blockage could be due to infection, injury, vasectomy operation gone wrong or structural deformity. 

In Non-Obstructive Azoospermia, sperms are not at all being formed.

TESA vs TESE?

TESA - No incision or surgery required. Only needle is inserted under local anaesthesia to extract the semen. Very low pain, less time required (10 min) and low charges.

TESE – Biopsy surgery done to extract tissue under General anaesthesia.  Takes a little more time, charges and recovery time, a little higher than TESA.

When should one go in for TESA?

1. Obstructive Azoospermia – i.e. sperms are produced but blocked due to various reasons like infection, absent vas deference, blockage in epididymis, vasectomy, failure to collect sperms by PESA.
2. Non-Obstructive Azoospermia with high FSH values – mediation is given to correct FSH levels and then sample is taken when sperms start getting produced. 
3. Testicular failure - which reduces ability to produce sperms due to chromosomal abnormalities. 
4. Varicocele – where formation of cysts causes the blockage of sperm out of testicles.

Procedure of TESA 

· Procedure is performed after spermatic cord & local skin block. 

· A large bore Angio catheter is connected with extension tubing to syringe. 

· Suction is applied through the syringe to extract testicular tissue. 

· This is performed at multiple times following the lobular planes of the testicles allowing adequate tubular removal. 

· Aspirated tissue is flushed in the petri dish or collection tube containing media. 

· After fine dissection with scissors & scalpels the tissue fluid is examined under microscopy to confirm sperm presence. 

· Repeat sperm aspiration can be performed either on the same or opposite testicle if needed. 

Advantage of TESA

It takes minimal invasive approach allowing fast recovery of patient. As it is done under local anaesthesia, patient can return to normal life right after procedure.

There is no need to close the scrotal skin as it will close on its own. 

Complications 

Bleeding & infection 

Procedure of TESE

 · TESE procedure is a surgery done under general anaesthesia. An incision is made to scrotal skin & testicular tissue is removed. 

 · Generally done with window technique in which the testicle & scrotum are stabilized & then 1 cm scrotal skin incision is done to extract testicular tissue.

 · Extracted tissue is then processed to find sperms, which will be used in IVF or ICSI. 

 · Scrotal skin incision is closed with absorbable sutures.

Complications

Bruising, Bleeding & infection 

Conclusion

TESA & TESE are two types of sperm retrieval procedures done to obtain a maximal amount of viable sperms for use in ART while minimising the damage to testis. 

These technique are used in both the cases Obstructive Azoospermia as well as Non Obstructive Azoospermia. 

In Obstructive Azoospermia retrieval can be done successfully in almost all the cases.

In Non Obstructive Azoospermia it remains a great challenge & sperm retrieval rate is only 25-40%. Micro - TESA technique is used in such cases where no sperms are found in TESA/TESE technique to get maximum success rate. 

Using these advanced techniques patient with any kind of sperm problem gets pregnancy through IVF or ICSI procedures.  

Akruti IVF Centre is having multiple treatments for Male Infertility, including TESA /TESE , PESA, Micro – TESA,MACS. First Andrology is done to establish the cause of the problem, then right technique is used by expert clinicians to extract sperms.