TESA (Testicular Sperm Aspiration)

TESA or testicular sperm aspiration is a needle biopsy of the testicle. It is an office procedure performed under local anesthesia. A small incision is made in the scrotal skin and a spring loaded needle is fired through the testicle. While it is possible to retrieve sperm using this technique, the amount is often low because the needle cuts a thin sliver of tissue. Many embryologists find this small amount of tissue difficult to work with and do not get enough sperm to freeze for future use. Several studies have demonstrated that TESE is superior to TESA in all regards. The potential for complications is higher with this technique than with TESE (open biopsy) for two important reasons. TESA is a blind needle stick and bleeding can not be stopped when it is accidentally encountered. The needle is larger in diameter than the intratesticular artery and can sever the artery, potentially cutting off testicular blood supply. The testicle may shrink and die. It is because of these reasons that we rarely offer TESA to our patients. Open biopsy (TESE) is more effective and potentially safer than needle biopsy (TESA) and is our technique of choice for obtaining testicular sperm for men with non-obstructive azoospermia.

Sperm are rarely present in the epididymal tissue of patients who have non-obstructive azoospermia. Therefore epididymal procedures such as MESA or PESA are inappropriate for retrieving sperm from these men. TESE or open testicular sperm extraction is the optimal technique for obtaining sperm in this situation. Men who produce very few sperm may need to have multiple areas of the testicle sampled before enough usable sperm are found. Needle biopsy does not yield as much tissue as open biopsy and therefore yields fewer sperm as well. An open biopsy should be performed before canceling an IVF cycle if no sperm are found on a needle biopsy.

Sperm aspiration (when performed using the appropriate technique) is usually a very successful, minimally invasive procedure that allows even men who make very few sperm to conceive a child of their own. Our goal at the Center for Male Reproductive Medicine is to provide the safest, most effective patient care and to collect as much good quality sperm as possible to minimize the need for future multiple surgeries.