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TESA

Testicular sperm aspiration or TESA is also known as Testicular sperm extraction or TESE.

TESA is a procedure to remove sperm from the testicle for use in advanced reproductive technologies. There are certain conditions that require TESA to obtain a pregnancy. These conditions are congenital bilateral absence of the vas deferens (CBAVD), or obstruction of the vas.

CBAVD is a situation where the vas failed to form prior to birth. The testicle may or may not be affected. I send a serum sample for a particular genetic study of these patients because about half of the patients with a congenital absence of the vas (CBAVD) have some form of Cystic Fibrosis (CF). Cystic Fibrosis was considered a disease of the lungs characterized by large cysts and fibrous deposition. This condition would lead to multiple, severe episodes of pneumonia and usually death by puberty. Recently, a lot of the genes associated with CF have been mapped and identified. As I said before, about half of the patients with CBAVD have the same genetic make-up as patients with CF, but they do not seem to have the pulmonary problems. Those with the genetic make-up of CF but who don’t have the disease are called carriers. Carriers are very common, so common in fact that now many obstetricians are recommending screening for CF routinely in their patients that wish to conceive. A primer of genetics is not the point of this article, but if a patient with CBAVD is tested for CF and found to be positive and if his spouse is also positive then this couple should undergo genetic counseling to determine the risk of giving CF to the offspring. Whether or not the patient or his spouse tests positive, if this couple would like to use his genetic material for reproduction, a TESA will be needed.

Five hundred thousand American men per year undergo vasectomy for elective sterilization. A number of them become divorced and remarried. Frequently these newlyweds consider ways of starting a family of their own. Vasectomy reversal is probably the most reasonable route for them. For patients that have failed vasal reconstruction, a repeat reversal is still more likely to achieve a pregnancy in most cases. But in a certain percentage of couples, this is not feasible and TESA is the procedure of choice.

A small number of men have an area of the vas or the epididymis that did not form properly or that developed some scar tissue in these delicate areas. This too can cause obstruction of the sperm outflow. TESA might be required in these circumstances.

There is a small percentage of patients that have a blockage of both vasa (the plural of vas is vasa) at the level of the prostate. This blockage can be removed by a resection of the prostate in this area. Sometimes that resection doesn’t work, there is still no sperm in the ejaculate. These patients would benefit from a TESA procedure

The TESA Procedure
The TESA harvests only a few sperm, not enough to perform simple artificial insemination, but enough to inject the sperm directly into the egg in a process called Intra-Cytoplasmic Sperm Injection or ICSI. In order to acquire the eggs, the female partner of the couple will need to undergo In Vitro Fertilization (IVF); this is done in concert with a female fertility specialist, also known as a Reproductive Endocrinologist. The husband is brought to the aspiration suite and the area is washed with an antibiotic cleanser. Local anesthesia is administered. A needle, which is attached to a silicone rubber tube, is passed across the scrotum and into the testicle. A vacuum is applied by a syringe and a small amount of fluid is removed. After four passes, the recovered material is evaluated in the adjacent lab. When there is enough sperm the procedure is terminated. The sperm is processed and frozen for future use. Typically, there is enough for at least two cycles of IVF.

Sometimes there is not enough sperm retrieved from the aspiration, and a simple biopsy is required. In that case a small incision is made in the scrotum, then in the testicle, and a small amount of tissue is removed. The scrotum is stitched together with suture that dissolves on its own. Usually, enough sperm are harvested from one side, but on rare occasions the other side is aspirated as well. Whether the sperm is obtained via TESA or biopsy, an ice pack is applied and should stay on for as much of the next 24 hours as possible.

If you have any questions, please call for a private consultation.

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