TESTICULAR EPIDIDYMAL SPERM ASPIRATION (TESA)
TESA is one of the newest state-of-the-art technology provided by the ART Program
of Alabama. The TESA procedure removes sperm directly from a man's testicles,
bypassing his reproductive tract. The ART Program has been successful in
retrieving sperm in over 75% of cases, reporting no difference in fertilization
rates in males requiring TESA compared to males with low sperm counts (total
motile sperm < 20 million when combined with Intracytoplasmic Sperm Injection and
Men who have a low or absent sperm count due to obstructive causes like
failed vasectomy reversal, absence of vas deferens or scar tissue in their
outlet track can benefit from this new procedure. This may also benefit
some men who make low levels of sperm due to problems in the testicles.
The TESA procedure is usually performed in the physician's office or outpatient
setting using a sedative to relax the man. The patient may encounter a slight
amount of brief pain but is usually able to resume normal activities the
The device the physician uses to collect the sperm has been used for years
to gather tissue samples in breast, kidney, liver and prostate biopsies.
The plastic device, which fits into the physician's palm, inserts a needle
about 1/2 inch into the testicle and removes a small sample of tissue. An
andrologist separates the sperm from other parts of the tissue by placing
the sample in a special medium. The medium triggers the sperm to break away
from the tissue - the first step in capturing it for the fertilization process.
Another special fluid is added to slow the sperm down to enable the andrologist
to catch them.
During the TESA procedure, as many 50 to 100 sperm may be collected. In
conjunction with IVF and ICSI technologies, one sperm is injected into
each egg retrieved from the wife, who has been given hormones to produce
multiple eggs. When a sperm fertilizes an egg, the initial stages of an
embryo begin to form in as little as 12 hours. Five days later, an embryo
is placed in the uterus and a pregnancy begins.
Of course, TESA does not entirely replace varicocele repair, vasectomy reversals
or open techniques for sperm retrieval including micro-surgical epididymal
aspiration and open testicular biopsies.
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