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PESA / TESE
These procedures are offered to couples in cases where the male has no sperm present in the ejaculate. They are used in conjunction with an ICSI procedure. (For more information please see the ICSI section).
In some semen samples there may be no sperm present in the ejaculate. There can be a variety of reasons for an absence of sperm known as Azoospermia.
PESA- Percutaneous Epididymal Sperm Aspiration
Option |
Advantages |
Disadvantages |
? Blood contamination Lots of sperm back/? Retrieval rates ? Risk of hematoma Best pregnancy rates |
Requires microsurgery expertise ? Cost General anesthesia Requires scrotal exploration ? Post-operative discomfort |
|
|
No microsurgery expertise required Local or general anesthesia Few instruments required Fast/Repeatable Minimal post-operative discomfort ? Cost |
Feasiblility depends on anatomy Less sperm back Blood contamination ? Risk of hematoma Damage to adjacent tissues |
No microsurgery expertise required Local or general anesthesia Few instruments required Fast/Repeatable Minimal post-operative discomfort ? Cost |
Less sperm back Blood contamination ? Risk of hematoma Risk of testicular damage/atrophy |
|
TESE |
No microsurgery expertise required Local or general anesthesia Few instruments required Fast/Repeatable |
If non-obstructive azoospermia, Then less sperm back. Risk of testicular damage/atrophy Scrotal exploration required |
Micro-TESE* |
Few instruments required Best for Non-Obstructive Azoospermia |
Microsurgical expertise required. General anesthesia Not fast/Time consuming Scrotal exploration required ??? Cost ?? Risk of testicular damage ?? Post-operative discomfort Minimally repeatable |
* Requires microsurgical expertise with fellowship-training preferable. |
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