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This procedure may be performed under GA or local anaesthetic with sedation. A small sample of testicular tissue is extracted from the testes. This can be achieved by either a fine needle being inserted into the testes or a small incision being made.
Sperm that is extracted by the above procedures will then be used in conjunction with an ICSI cycle. ICSI involves a selected single sperm injected directly into a mature egg. The eggs will then be placed in an incubator and checked the following day for fertilisation. An Embryo Transfer is normally scheduled 3-5 days following egg collection.
TESA is a simple procedure and there is less risk of complications compared to an open surgical operation. Patients usually return to work the following morning after the procedure. It is carried out as an outpatient procedure under intravenous sedation, local anaesthesia or a combination of both. The procedure does not take long. Because some patients have 'islands' of sperm producing tissue within the substance of the testicle, the TESA technique is more likely to pick up such 'islands' of tissue compared to the older technique of open testicular biopsy.
TESA is also indicated in the few patients with obstructive azoospermia in whom PESA has not been successful due to damage or scarring of the epididymis or defective sperm production in the testes which can also be associated with an obstruction.
We sometimes recommend performing a diagnostic PESA/TESA procedure at least 3 months before the planned IVF/ICSI treatment cycle. If motile sperm are recovered, either from the epididymis or testes, the sample may be frozen in small tubes, or straws, for several treatment cycles. This saves patients the need for a repeat procedure.
When IVF and ICSI treatment is planned we prefer to book the patient for a "back up" procedure on the day of their wife's egg collection, in case the frozen sperm/tissue does not survive the thawing process after having been frozen which happens occasionally.
What are the indications for such a procedure?
There are many reasons why a TESA/E may need to be performed, but all involve an inability to produce an ejaculate with sperm sufficient for fertilization. Some examples are obstructive and non-obstructive azoospermia (NOA), CBAVD, and history of a vasectomy.
In men with obstructive azoospermia,( because of duct blockage or absence of the vas deferens) , sperm are usually recovered from the epididymis. The original technique was devised by a urologist, Dr Sherman Silber, who is a specialist in microsurgery. He used a method called MESA, or microepididymal sperm aspiration, in which the scrotum was opened, and an operating microscope used to identify the epididymal tubules which were distended with sperm. While this method was very successful, it was very complex, since it needed an operating microscope; and therefore very expensive as well.
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 is no scar at all. This is why this is the preferred method of choice in most centers in India.
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