TESA/Micro TESE Treatment Centre in Delhi

TESA:

TESA, or Testicular Sperm Aspiration, stands as one of the latest advancements in sperm retrieval techniques, particularly recommended for men diagnosed with Azoospermia—a condition characterized by the absence of sperm in the ejaculate.

Previously, treatment options for azoospermia were limited to reconstructive surgery (for cases of obstruction) or donor insemination.

However, the emergence of intra-cytoplasmic sperm injection (ICSI) has revolutionized fertility treatment, enabling many azoospermic men to become biological fathers by using sperm retrieved from their epididymis or testis.

This surgical procedure is typically employed in two scenarios:

Non-obstructive Azoospermia: where the testicles are unable to produce sufficient sperm.
Obstructive Azoospermia: where a blockage prevents sperm from passing into the semen.

Poor sperm production can significantly impact fertility, making TESA a pivotal breakthrough in directly retrieving sperm from the testis. Men with azoospermia can potentially father children if sperm is successfully retrieved from their testis or epididymis.

Specifically, TESA is utilized for men with non-obstructive Azoospermia, where sperm retrieval from the epididymis is not feasible.

Procedure Overview:

During TESA, a needle is inserted into the testis to aspirate fluid and tissue using negative pressure.
The retrieved sample undergoes processing in the embryology laboratory to extract sperm cells, which are then utilized in the ICSI procedure (Intracytoplasmic sperm injection).

It’s important to note that sperm obtained through TESA may be immature and require ICSI for fertilization. In ICSI, a single sperm is directly injected into an egg, bypassing the need for sperm maturity.

TESA may cause discomfort for a few days post-procedure, as it involves a slightly complex process.
However, it is typically performed under local anesthesia or sedation as per the patient’s preference, often as a day care procedure without the need for hospitalization. In cases where TESA fails to yield sufficient sperm, a testicular biopsy may be necessary.

While TESA offers hope for infertility treatment, concerns have been raised regarding the use of genetic material from developing sperm cells, as well as the potential transmission of infertility causes to offspring.

These considerations underscore the importance of comprehensive counseling and informed decision-making in fertility treatment.

micro-TESE:

Non Obstructive Azoospermia (NOA) is the absence of sperm in the ejaculate due to a failure in spermatogenesis. It is the most severe form of male infertility caused by intrinsic testicular failure or inadequate gonadotropin production. However, microsurgical testicular sperm extraction (microTESE) may offer men with a diagnosis of NOA a pathway to biological parenthood.

According to the most recent American Urological Association and American Society for Reproductive Medicine male infertility guidelines, men with NOA should be offered microTESE. MicroTESE is a surgical procedure where sperm is retrieved from the seminiferous tubules of the testis.

How is micro-TESE performed?

While patients with NOA may not have sperm detectable on a semen analysis, they may have focal areas of sperm production within the testis. During a typical microTESE procedure, a surgeon spends hours searching for sperm using an operating microscope. And a reproductive endocrinology lab technologist can spend up to 14 hours searching under a bench-top microscope. Here is what the surgical field looks like during the procedure at 10 to 15 times magnification.

Sperm retrieval rates are 40% to 60% for microTESE, and any sperm found needs to be used for in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Due to the specialised nature of this procedure, it is typically done at a facility in conjunction with reproductive endocrinologists. MicroTESE has traditionally been performed in the operating room under general anesthesia, posing a financial barrier for couples who do not have insurance coverage for fertility care.