Testicular sperm aspiration procedure (TESA)

Testicular Sperm Aspiration is an artificial reproductive technique used to overcome male infertility. It involves the withdrawal of sperms from the testis with the help of a needle under local anaesthesia. A single sperm is then used to fertilise the female partner’s egg through a method called Intracytoplasmic Sperm Injection (ICSI).

Sperms are produced in coiled tubes in the testes called the seminiferous tubules. These tubules are connected to another set of tubes called epididymis which is further connected to vas deferens. The sperms have to pass through all these before getting deposited in the semen and released during ejaculation through the penis.

Who should opt for TESA?

Following patients are potential candidates for TESA:

  1. Patients having Azoospermia (complete absence of sperms in the ejaculate). The causes can be:
  • Obstructive- Sperm production is normal, but there is a blockage somewhere in the sperm passage from testis to penis (vasectomy-i.e. cutting and sealing of vas deferens done as a male contraceptive method; malformation of any of the passages; previous history of surgery or infection in the passage causing a scar; absence of vas deferens at birth)
  • Non-obstructive- decreased sperm production [pituitary defects; benign cysts(varicocele); testicular failure;chromosomal abnormalities]. The implication of chromosomal abnormalities needs to be assessed before going ahead with TESA.
  1. Asthenospermia- immotile but alive sperms that are unable to travel the passage and therefore are absent in the ejaculate.
  1. If vasectomy removal surgery has been performed and failed, then TESA is a good option.

Who performs TESA procedure?

TESA is usually performed by a urologist or a reproductive endocrinologist who has specialised in infertility cases. This is an office procedure requiring merely 30 minutes.

What is the process?

  1. Initial investigations comprise of Hormone levels: FSH, LH, Testosterone
  2. Chromosomal analysis
  3. Ruling out infections like HIV, Hepatitis B  and C
  4. Physical examination of testes
  1. TESA involves removal of few seminiferous tubules using a fine needle. The sperms are then isolated from these tubules in the laboratory.
  2. The female partner undergoes ovulation stimulation through hormone administration followed by egg removal (as in IVF).
  3. The collected sperms can be used fresh or collected, frozen and thawed later for future use.
  4. Fertilisation is attempted by Intracytoplasmic Sperm Injection technique (ICSI).
  5. Enough sperm is aspirated and stored in multiple phials and used for repeated IVF attempts.

What is the success rate of TESA?

The success rates are similar to that of IVF. It largely depends on the age of the female partner, her fertility status and antral follicle count.

Advantages:

  1. TESA is a simple, least invasive and a quick procedure.
  2. It makes childbearing possible for men who are labelled infertile due to lack of sperms in the ejaculate.

Disadvantages:

  1. TESA itself doesn’t guarantee success. The reproductive state of the female partner plays an equally important role without which TESA can be a failure.
  2. It is difficult to find sperms in patients with testicular failure or reduced sperm production
  3. It is an expensive procedure.

Complications like bruising, infections may be encountered

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