Micro Tese / Tesa


In some individuals, spermatozoa may not be present in the ejaculate. This condition is called Azoospermia. This can be either due to problems in sperm production itself or due to obstruction to the flow of semen during ejaculation. Reproductive tract obstruction can be acquired - as a result of infection, trauma, iatrogenic injury which can occur during bladder neck, pelvic, abdominal or inguino-scrotal surgery. Congenital anomalies may be relatively uncommon in the general population, but can occur in up to 2 percent of infertile men. Best known condition is congenital bilateral absence of the vas deferens (CBAVD) which occurs in almost all men with cystic fibrosis. In the event of absence of vital sperms in the ejaculate, the possibility of getting sperms by surgical means from epididymis (PESA or MESA) or from testicle (TESE/TESA) should be considered.

PESA or Percutaneous Epididymal Sperm Aspiration (PESA), does not require a surgical incision. A small needle is passed directly into the head of the epididymis through the scrotal skin and fluid is aspirated. The embryologist retrieves the sperm cells from the fluid and prepares them for ICSI.

Microsurgical Epididymal Sperm Aspiration (MESA) is used in conditions like obstructive azoospermia, involves dissection of the epididymis under the operating microscope and incision of a single tubule. Fluid spills from the Epididymal tubule and pools in the Epididymal bed. This pooled fluid is then aspirated. Because the epididymis is richly vascularized, this technique invariably leads to contamination by blood cells that may affect sperm fertilizing capacity in vitro.

TESE or testicular sperm extraction is a surgical biopsy of the testis whereas TESA or testicular sperm aspiration is performed by inserting a needle in the testis and aspirating fluid and tissue with negative pressure. The aspirated tissue is then processed in the embryology laboratory and the sperm cells extracted are used for ICSI. How is the Micro-TESE procedure performed? In the micro-TESE procedure, the testis is completely opened with a single incision. The tissue is then magnified 24 times with a microscope to identify areas likely to produce sperm. As sperm-producing channels are easily seen and recognised, the urologist performing the procedure can collect the necessary tissues. These tissue samples are subjected to a number of treatments to separate the live sperm cells therein. If live sperm is found, and the eggs collected from the mother are ready for microinjection, the IVF procedure is performed straight away. If there are any remaining sperm cells, they are frozen and stored for future IVF treatments.

The micro-TESE procedure yields a much higher number of spermatozoa than conventional biopsy methods. Thanks to this procedure, sperm is extracted from the testes of men who have no sperm production (azoospermia), so that they can father biological children. In rare cases, micro-TESE is performed on men with poor sperm quality to obtain healthy sperms. Another advantage of the micro-TESE procedure is the following: since the magnification under the microscope allows for a much better observation of the vessels, damage to the testes is minimised.