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06 February 2017

Male Infertility Treatment With TESA

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Written by Dr. Neha Gupta
Sperm recovered from TESA procedure later used for ivf treatment or procedure. IVF treatment or test tube baby is required for fertilization with TESA sperm

Sperm recovered from TESA procedure later used for ivf treatment or procedure. IVF treatment or test tube baby is required for fertilization with TESA sperm

TESA can be used as a diagnostic procedure to detect azoospermia (a condition whereby a man has no sperm in his seminal fluid), or as a methodology to recover sperm from the testicles of men with infertility problems and impediments or ejaculatory issues that cannot be treated by any other methods. TESA is actually a surgical biopsy of the testis done to retrieve sperm when ejaculation and discharge are not possible. TESA is done before starting the IVF procedure or IVF treatment and before making an embryo in test tube baby procedure. 

In the TESA procedure, a fine needle is passed into the testicles under anesthetic, and a tiny amount of material is expelled from the seminiferous tubules ( a fertilization network of tiny tubes where sperm are produced). These tubules are then processed in the laboratory and checked for the presence of sperm, which can be either utilized to fertilize eggs. 

Sperm recovered from the seminiferous tubules in a TESA procedure are less mature and less versatile than sperm found in ejaculated seminal liquid. As such, Intracytoplasmic Sperm Injection (ICSI) – a specialized form of In Vitro Fertilisation (IVF) – is required for fertilization with TESA sperm to deal with infertility. TESA is actually a surgical biopsy of the testis done to retrieve sperm when ejaculation and discharge are not possible. TESA is done before starting the IVF procedure or IVF treatment and before making an embryo in test tube baby procedure. 

When to go for TESA treatment?

Testicular sperm extraction is indicated for below patients:

  1. There is a blockage in the epididymis very near the testis (either from prior surgery, infection or from birth)
  2. Blockage within ducts of the testes (efferent ductules).
  3. Poor sperm production, in which so few sperm are produced that they cannot reach the ejaculate.

What does TESA procedure involve?

When the release of sperm is prevented by a blockage in the vas deferens, or by a vasectomy, a few techniques can be used to recover the large numbers of sperm that remain inside the testes. The initial three involve aspirating sperm using needles or tubes put through the skin of the testis and are carried out under local anesthetic. TESA is actually a surgical biopsy of the testis done to retrieve sperm when ejaculation and discharge are not possible. TESA is done before starting the IVF procedure or IVF treatment and before making an embryo in test tube baby procedure. The fourth requires open surgical sperm retrieval and is usually carried out under general anesthetic. Testicular sperm aspiration. This includes placing a needle joined to a syringe through the skin of the scrotum and simply sucking out the liquid inside the testicle.

There are 2 options for doing a TESA - diagnostic; or therapeutic. In a diagnostic TESE, the surgeon performs multiple diagnostic biopsies to determine if sperm is being produced in the testes or not. If no sperm is found, the diagnosis of complete testicular failure is confirmed; and treatment options then include adoption or donor insemination, since there is no treatment at present for this condition of infertility. TESA is actually a surgical biopsy of the testis done to retrieve sperm when ejaculation and discharge are not possible. TESA is done before starting the IVF procedure or IVF treatment and before making an embryo in test tube baby procedure. If sperm is found, then these testicular sperms can be cryopreserved; and used for In Vitro Fertilisation (IVF) or ICSI treatment in the future.

What is the success rates of TESA with IVF or ICSI?

The success rate will depend very much on the IVF live birth success rates of the particular in vitro fertilization lab. IVF success rates are also dependent on the age of the female partner. I would generally expect the success rates to be about the same as (or somewhat higher) the rates for other couples with a female partner of the same age going through IVF.

The female partner's ovarian reserve is best measured by the antral follicle count that is a good predictor of the chances for successful IVF outcome either.

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