Overview
Testicular Sperm Aspiration (TESA) is a simple technique in which sperm are directly aspirated from the testis for immediate use or to store for future use. It is recommended for men with obstructive azoospermia. In this article, we will explain when TESA is recommended, how the procedure is done, the success rates, and the comparison with other similar techniques used in fertility treatments.
What is TESA?
Testicular Sperm Aspiration (TESA) is a simple and minimally invasive technique in which a needle is inserted into the testis to aspirate seminal fluid containing sperm. The received material is examined in the lab for the presence of sperm. If sperm are present, they may be used immediately for an IVF/ICSI procedure or frozen to be preserved for future use. It is a quick and less invasive procedure, and the best option to retrieve sperm.
Indications for TESA
TESA is required in the following cases:
- It is used when men suffer from obstructive azoospermia, a condition in which sperm are produced but cannot reach the semen due to blockage of the spermatic duct. The blockage may occur due to epididymal obstruction, vasectomy, or congenital absence of vas deferens.
- Many men have retrograde or failed ejaculation, in which ejaculation is not possible, or semen cannot be collected.
- TESA is used if the ejaculate does not contain sperm, and the couple plans for ICSI because ICSI needs a single live sperm to fertilise an egg. Therefore, sperm retrieved through this procedure are used for ICSI.
- It is useful when only a few sperm are present in the semen.
- This procedure is used before proceeding to more invasive procedures, such as micro-TESE, if needed.
Step-by-Step Procedure of TESA
- The doctor will take your medical history and personal history and recommend blood tests for infections. A scrotal ultrasound is recommended if required. The doctor will explain the procedure, risks, and alternatives in the first meeting.
- The procedure is done under local anaesthesia in an outpatient department. In some cases, a short general anaesthetic may be given when combined with other procedures.
- Under sterile conditions, the doctor will insert a fine needle into the testis to aspirate seminal fluid and tissue. Multiple attempts are made to aspirate possible sperm.
- The aspirated material is sent to the laboratory for microscopy to assess viability. If sperm are found, they may be used immediately for ICSI or frozen for future use.
- Patients are advised to take rest for a few hours and can go home the same day. Mild scrotal pain and swelling may occur after the procedure, but they will resolve within a few days.
Benefits of TESA
- TESA is a minimally invasive procedure, and it takes very little time.
- It can be performed under local anaesthesia in the outpatient department.
- It is an affordable procedure, and recovery is quicker than other similar procedures.
Limitations of TESA
- TESA has some limitations: it is a blind-needle technique, and samples are taken from small areas of the testis; therefore, it may miss focal pockets of sperm production, especially in men with non-obstructive azoospermia.
- It offers fewer sperm as compared to TESE/micro-TESE.
Success Rates Related to Fertilisation and Pregnancy
The success rate of TESA depends on the underlying diagnosis.
- In obstructive azoospermia, TESA has a good sperm retrieval success rate because sperm are produced but blocked.
- In non-obstructive azoospermia, there is impaired sperm production, and the TESA retrieval rate is low. Results can improve by using micro-TESE by helping to visualise directly and obtain a targeted sample.
- In severe oligozoospermia, micro-TESE may show better results than TESA.
Risks and Complications of TESA
TESA is a safe procedure, but some risks are involved. Possible complications of TESA include:
- Infection may occur if proper sterile technique is not used for the procedure.
- Scrotal pain and swelling last longer
- A hematoma in the scrotum may occur due to multiple passes
- Damage to the testicular tissue may occur rarely if repeated frequently.
TESA vs. PESA vs. TESE vs. Micro-TESE- Which is the Right Method
- PESA (Percutaneous Epididymal Sperm Aspiration) : It is the best procedure for obstructive cases when mature sperm are available in the epididymis, but it is not useful if obstruction is intratesticular.
- TESA : It is a quick and minimally invasive procedure, the best choice in obstructive azoospermia or when ejaculate retrieval fails.
- TESE (Open testicular biopsy) : In this procedure, a small piece of testicular tissue is removed through an incision. It gives more tissue and sperm than TESA.
- Micro-TESE (microsurgical TESE) : This procedure is done under an operating microscope to identify visible dilated tubules that contain sperm. It is the best method for men suffering from non-obstructive azoospermia, and it increases the chances of sperm retrieval with minimal tissue loss.
Integration of TESA and IVF
TESA IVF is a combined fertility treatment in which sperm are retrieved during in vitro fertilisation. It gives the best option for couples facing male-factor infertility. The success of IVF implantation with testicular sperm aspiration (TESA) will depend on many different variables, including the quality of the retrieved sperm, the female partner's fertility, the quality of the retrieved eggs, the ages of both partners, and, lastly, on the skills and expertise of the fertility clinic performing the procedure. This approach provides hope for couples who experience difficulties in getting pregnant.
Tips for Couples
A TESA procedure is typically scheduled when new sperm are needed to coordinate with an ongoing IVF cycle. The doctor concurs with the partner’s egg retrieval with TESA, and couples can also choose cryopreservation or a backup sample for future use.
The success of an IVF procedure is based on the quality of the egg, the age of the mother and on having a successful sperm retrieval from TESA.
Success also relies on laboratory results, processing skills with small samples, and the surgeon's experience.
In cases of non-obstructive azoospermia where TESA fails, micro-dissection Testicular Sperm Extraction (micro-TESE) may be employed and has a better chance of retrieving sperm.
Conclusion
TESA (Testicular Sperm Aspiration) is a minimally invasive procedure that has helped people to achieve conception, bypassing male factor infertility. It is the best method used for obstructive azoospermia. It is a simple and safe procedure, but it has limitations as it yields a poor sperm retrieval as compared to microsurgical techniques. You should discuss everything about TESA with your fertility expert, including success rates, coordination with IVF/ICSI cycles, its benefits, risk factors, and complications, to understand the entire process.
Table of Contents
Common Questions Asked
Is there a risk of birth defects with TESA?
There is no risk of birth defects or congenital anomalies with TESA, but couples must discuss the risks and complications with the fertility expert before going through the procedure.
What are the other options if TESA fails?
If TESA fails, the doctor may repeat the process, use open TESE, or micro-TESE, which is the preferred method in non-obstructive azoospermia.
How soon can I recover after a TESA procedure?
You can go home the same day after the TESA procedure. Mild pain and swelling may occur for a few days, which resolve quickly. Doctors advise avoiding heavy lifting and strenuous exercise for a few days.
Will I feel pain during TESA?
The doctor will give local anaesthesia before the TESA procedure. During the procedure, you may have slight pain. The pain will only last for one to three days afterwards, and the pain can be controlled with over-the-counter pain medication like aspirin or ibuprofen.
What are the long-term side effects of TESA?
The TESA procedure does not produce any long-term side effects. You may experience dull pain, slight bruising, and discomfort for a few hours. Infection may occur rarely if sterile techniques are not observed.