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Testicular sperm aspiration (TESA) or Testicular Sperm Extraction (TESE) is a sperm retrieval procedure performed for men with Azoospermia. A needle is used to aspirate sperms and tissue from the testis. Sperm retrieved from TESA treatment are used for IVF, IUI and ICSI.
What is TESA Treatment?
TESA or Testicular Sperm Aspiration is a medical procedure of sperm extraction for the treatment of male infertility problems. In this procedure, a needle is penetrated in the testicles and fluid and tissue with workable sperm are extracted for Assisted Reproductive Techniques such as ICSI (Intracytoplasmic Sperm Injection), IVF and IUI. Under the impact of anesthesia, small testis tissue and sperms are taken out. TESA is a breakthrough technology in which even immature sperm can also be utilized to fertilize egg but it has to go through the procedure of ICSI.
When is TESA Done?
TESA is performed under various conditions as discussed below:
1- TESA is performed when a male is diagnosed with problems in semen or sperms in sperm culture reports or in semen analysis tests such as:
- Azoospermia (complete absence of sperm during ejaculation) and Non-Obstructive Azoospermia (Abnormal sperm production)
- Oligospermia (low concentration of sperms)
- Asthenozoospermia(sperms lacking the required motility)
- Cryptozoospermia (sperms with high casualty rate)
- Necrozoospermia (a condition with dead and immobile sperms).
2- When the person has a long history of various genital surgeries and issues such as:
- Vasectomy(surgery for permanent contraception of men)
- Frenulectomy (Removal of frenulum of the penis to correct condition of frenulum breve/breaching)
- Penectomy (Surgical removal of penis)
- Urethrectomy (Surgery to remove male urethra- a tube connecting urinary bladder and male genitalia)
3- Men with Retrograde Ejaculation problems (ejaculation happening inside the urinary bladder instead of coming out of the urethra.
What is the difference between TESA and TESE?
TESA is a clinical based procedure and is performed with local anesthesia. Once the both or one of the tests are numbed, a needle is used for aspirating sperms along with testicular tissue. Sperms are then assessed by andrologist. Good quality sperms are cryopreserved, by using appropriate techniques. TESA is useful for those who have adequate sperm production throughout the testicles. No incision is required in TESA.
TESE is also performed under the impact of local anesthesia. But TESE requires a small incision for exposing the testicular tissue. TESE extracts high number of sperms with good quality and mobility as compared to TESA. This procedure is good for those who are confident that sperm is produced but are not good for a percutaneous procedure. TESE costs more than TESA.
Both the techniques, TESE or TESA can be used. The only difference is TESE involves a surgical biopsy of the testis and in TESA a needle is stick into the testis, which is used to aspire fluid and tissue with the negative pressure. Consult the doctor before selecting any procedure.
How to prepare for the Procedure of TESA?
It is important to inform your doctor if you have any of the following issues before undergoing testicular aspiration:
- If you had any bleeding problems.
- If allergic to any medication which also includes anesthetics.
- If taking any medicines regularly then it is important to tell your doctor about all the medications you are going through along with over the counter ones.
- If you are taking blood-thinning medicines like warfarin, heparin, enoxaparin, aspirin, ibuprofen and other NSAIDs.
- Apart from these details, the patient will be asked to sign a consent form, which will state that 'you understand the risks involved in the test and agree to have it done'.
- You must talk to your doctor if you have any confusion or concerns regarding the requirement of the test. You can also clear about the risks and complications involved. You can also talk about the results.
- You don’t have to do anything or any preparation if a biopsy is performed under local anesthesia. But if the procedure is done under general anesthesia, then the doctor will ask you to how soon before the procedure you should stop eating and drinking.
Follow the instructions carefully or it may delay the surgery. The doctor will insert an intravenous line (IV) in your arm before the test. The doctor will also get a sedative medicine about an hour prior the test.
What are Different Sperm Retrieval Techniques used?
Below are the techniques, which can be used for the sperm retrieval:
1- Open fine needle aspiration- the epididymis is exposed and a ductile punctured via tunica directly without making any dissection. A 26-G needle is used.
2- Percutaneous epididymal sperm aspiration (PESA)- Simple, quick and easy process and no need to have open surgery.
3- Testicular sperm aspiration (TESA)- It is similar to aspiration cytology procedure i.e. a non-surgical process.
4- Needle aspiration biopsy- A simple, incision less and quick process which can obtain tissue equal to open biopsy.
5- Conventional open biopsy- with the help of scrotal incision testis is exposed and tunica is incised. And then a piece of testicular tissue is excised. An incision is closed once the tunica is sutured.
6- Single seminiferous tubule biopsy- this procedure involves extensive sampling of testis without any significant incision on tunica.
There are other methods also apart from the above mentioned and can be discussed with the doctor.
How does TESA Procedure Work?
The procedure for TESA is very simple.
1- First, the patient is injected with general/local anesthesia.
2- Following anesthesia, a very tiny and smooth needle is injected around testicle/s with a suction syringe.
3- Sperms and small testicular tissues are extracted through the needle. The extracted sperms and tissues are sent to the laboratory. Retrieved sperms and tissues are then tested under laboratory for sperm processing.
4- After that, the processed sperm is washed and most motile and healthy sperm are prepared for insemination.
How will you feel while undergoing TESA treatment?
1- During the test, you will feel a brief sting when the doctor will insert IV line in your arm or during local anesthesia is given. You won’t feel pain apart from it.
2- You may also experience some bruising.
3- You will also notice a small amount of bleeding through the bandage used. It is normal and you can discuss with your doctor how much bleeding you can expect.
4- Your doctor can also prescribe painkillers and antibiotics to reduce the pain and chances of infection.
Results of TESA
1- You can get the result from the testicular biopsy usually in 2 to 4 days.
2- The pathologist will observe the sample through a microscope. He/ she will then look for any abnormality in the sperm.
3- Sometimes, it may seem the normal development of sperm but once you get your semen analysis done, it will result in absent or reduced sperm. In such situations, it can be the blockage in the tube from testes to the urethra. The tube is known to be the Vas Deferens. Surgery can be performed in some blockage cases.
What factors can affect the test?
While under local anesthesia, it is really important for the patient to stay still. If the patient finds it difficult, then general anesthesia might be required.
What can be the possible repercussions?
When a testicular biopsy is performed, there are chances of testicular cancer. This is the reason why the biopsy is not performed if the cancer is suspected.
For diagnosing suspected testicular cancer, testicular ultrasound is often performed. And an open surgical procedure (orchiectomy) is done if the doctor thinks you might have cancer for confirming the diagnosis.
What are the TESA Benefits and Risks?
TESA is one of the effective methods of sperm retrieval. It is used vehemently in ART (Assisted Reproductive Technology) methods such as IVF, ICSI, and IUI. Some of the benefits and risks associated with TESA are given below.
- TESA is an easy and a non-surgical procedure.
- It is cost effective. It cuts down the need for expensive injections of superovulation to the woman.
- Less painful and less traumatic as no blood vessel is touched during TESA.
- It saves you time as the entire procedure of TESA procedure hardly needs 30-45 minutes.
- If you are not looking for sperm donor to conceive your child, TESA is best as it gives you the joy of being the biological father.
- TESA entails the risk of excessive bleeding internally.
- Risk of damaging testicular tissue if not operated properly is also there with TESA.
- The occurrence of intra-testicular hematoma (irresistible scrotal pain and trauma) hemorrhage is a potential threat to TESA.
- One may get fever as high as 104 degrees Fahrenheit after a surgery of TESA.
- Feeling of nausea and vomiting is there for at least some days after TESA treatment is done.
What is the cost of TESA Treatment?
TESA is very cost-effective. It costs approximately INR 15000 to INR 25000.
TESA treatment is one of the ways to treat male infertility. Medical Science also has other ways too for the treatment of male infertility. Please feel free to read our article on Treatment for Male Infertility.
SOURCES AND REFERENCES:
- How long does sperm live? Sperms, Elawoman - 2017
- Facts on semen color and semen health semen, Elawoman - 2017
- What is icsi ICSI, Elawoman - 2017
- Everything you need to now about intrauterine insemination (iui) IUI, Elawoman - 2017
- Things nobody tells you about donating sperm sperm donor, Elawoman - 2017
- Treatment for male infertility Treatment for Male Infertility, Elawoman - 2017
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