PESA is a procedure performed for men who are having sperm retrieved for IVF/ICSI who have obstructive azoospermia from either a prior vasectomy or infection.
Azoospermia is a condition where there are no sperm at all in a man’s ejaculated semen and there can be various reasons for this.
Sperm production and delivery involves a system of tubes within the male reproductive system. Sperm are initially produced in the testis in fine tubes called seminiferous tubules. In each testis these tubules are connected to a larger coiled tube called the epididymis in which sperm are held for a short while after production. The epididymis is in turn connected to the vas deferens which lead to the urethra. Sperm must move through this system in order to be deposited in the semen during ejaculation.
Azoospermia can be caused by an abnormality or blockage in the epididymis or the vas deferens. This is referred to as obstructive azoospermia. In these cases, sperm are being produced in the testes, they just can’t get out.
Sometimes however, sperm production in the seminiferous tubules does not occur at all or is happening at such a low level that sperm are not detectable in the ejaculate. This is referred to as non-obstructive azoospermia.
Using surgical procedures to try and extract sperm from the epididymis (PESA) or to dissect it out of tubules from the testis (TESA) can be an effective way of diagnosing what is causing the azoospermia.
More importantly though, these procedures can also be effective ways of isolating sperm for use in treatment to try to achieve a pregnancy. Even in non-obstructive azoospermia, as long as some sperm production is occurring, PESA/ TESA can still be an effective way of retrieving sperm for use in treatment.
PESA involves passing a fine needle through the skin into the epididymis to obtain sperm. TESA involves passing a fine needle through the skin directly into the testes and retrieving a small number of the seminiferous tubules themselves. The tubules are then dissected in the laboratory and the contents searched for the presence of sperm.
Both of these surgical procedures can be performed under either local anaesthetic or sedation. Your doctor will talk to you about which approach is suitable for you.
This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.