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TESA/PESA, Male Infertility Treatment in Delhi

Male infertility is dealt with in a specialized way. All men have the facility of advanced semen analysis. The causes could be testicular, pre testicular, or post testicular. A complete hormonal assessment is done where needed. A genetic analysis may be needed in patents with extremely low sperm counts. In cases of azospermia (absent sperms) testicular or epidydimal sperm extraction can be done and an ICSI performed.

Diagnosis can involve a medical history from the man to find out whether there are any obvious health problems that could affect fertility.
• A physical examination is done, along with a semen analysis to check the number, movement and shape of the sperm in the ejaculate. See advanced semenanalysis
• Blood tests may also be done to check the hormone levels that control sperm production.
• Genetic investigations to test for chromosomal anaomalies or Y chromosome microdeletion .

Treatment is available for male fertility problems. Male infertility treatment options include
1. Surgery
2. Medication
3. Hormone treatment

Donor sperms from another man can be used for fertilization if the patient wishes so.

Two of the most common treatments include

1. Intrauterine insemination (IUI)
2. Testicular sperm extraction with Intracytoplasmic sperm Injection
3. PESA (Percutaneous Epidydimal Sperm Aspiration) and TESA (Testicular Sperm Aspiration) are procedures that are performed to obtain sperm in certain cases of male infertility. PESA or TESA can be performed on men that have zero sperm counts due to either a sperm production problem or a blockage in their reproductive tract, such as the result of a vasectomy, congenital absence of vas deferens, or infection.

Once a diagnosis of azoospermia (zero sperm count) has been made, we work closely with a urologist with specialized training in male infertility who will retrieve the sperm. The urologist will first perform an exam and further testing which may involve blood work and/or a testicular biopsy. The result of these studies determine which procedure is more appropriate and more likely to yield sperm.

TESA/ PESA can be performed at our Center the morning of the egg retrieval, however in cases where the partner is not readily available the procedure can be done prior to the egg retrieval and the sample is preserved for later use. With PESA, a small needle is placed into the epidydimis, which is a reservoir of sperm that sits atop each testicle, using local anesthesia. During TESA, sperm is obtained by means of a biopsy of the testicle. The sperm obtained from these procedures is then injected directly into the eggs (ICSI).

A. Percutaneous epididymal sperm aspiration (PESA) is a technique used to extract sperms in the event of a possible blockage of the vas deferens. A small needle is inserted through the skin of the scrotum to collect sperm from the epididymis, where sperm are usually stored after production in the testes. It can also be used to extract sperm for Intracytoplasmic Sperm Injection (ICSI).

PROCEDURE

  • PESA is carried out under local anaesthetic.
  • A fine needle will be inserted into the epididymis. Sperm can then be removed with gentle suction.
  • Mild painkiller may be administered to the patients, in case of any discomfort after the procedure.

PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION (PESA)

Indications of ICSI with epididymal spermatozoa obtained by microsurgical epididymal sperm aspiration

  • Congenital bilateral absence of the vas deferens (CBAVD).
  • Failed vasoepididymal anastomosis.
  • Failed vasovasal anastomosis.
  • Obstruction of both ejaculatory ducts.
  • Anejaculation because of spinal cord injury.
  • Retrograde ejaculation.

B. TESTICULAR SPERM ASPIRATION (TESA)
TESA or testicular sperm aspiration is one of the surgical sperm harvesting techniques used for retrieving sperm in patients. A number of surgical sperm retrieval or recovery methods have been devised to recover sperm from the male reproductive tract.

Procedure

  • A needle biopsy of the testicle is done as an office procedure using local anaesthesia.
  • A small incision is made in the scrotal skin and then a spring loaded needle is gently inserted into the testicle.
  • The amount of tissue obtained is low because the thin needle removes only a thin sliver to tissue.

Indications
Indications of ICSI with testicular spermatozoa (TESA)

  • Extensive scarring, rendering MESA/PESA impossible.
  • Germ-cell hypoplasia (hypospermatogenesis).
  • Germ-cell aplasia with focal spermatogenesis.
  • Sertoli cell-only syndrome with focal spermatogenesis.
  • Frozen Embryo Replacement Cycle (FERC)

If the cycle has produced more than two (or three) good quality embryos, those that aren’t transferred, may be frozen for future use. These embryos will be frozen at extremely low temperature (-180°C), which ensures that they do not deteriorate over the number of years they are stored.

In a Frozen Embryo Transfer Cycle, the woman takes medications to prepare her womb to receive these embryos. The advantage of frozen embryo implantation treatment is that there is no need to use hormone injections to stimulate the ovaries.

An ultrasound scan is performed to assess the lining of the uterus to determine whether it is ready to receive the embryo. Once the lining is ready, embryos are thawed and transferred.