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Percutaneous epididymal sperm extraction (PESA) is the best treatment option  for a man who has obstructive azoospermia (zero sperm count because of a block in the reproductive tract).

Azoospermia, as the name suggests, is a condition in which there are no sperm in the semen. Most men are shocked to hear they suffer from this condition as even men with 0 sperm count have a normal libido as well as normal sexual function and their semen also looks normal. This particular diagnosis can be made only by examining the man’s semen under a microscope in a lab.

Azoospermia is different from aspermia (absence of semen). This is a very rare condition, in which the man cant produce a semen sample, as he cant ejaculate. This could be due to a problem called anejaculation; or even a medical problem known as retrograde ejaculation, in this the semen is discharged backwards and goes into the into the urinary bladder, instead of  forward.

Percutaneous epididymal sperm extraction (PESA) is done in conjunction with ICSI (intracytoplasmic sperm injection); in this, epididymal sperm are injected into the eggs to fertilize them. We use a very painless technique at our clinic to extract the epdidiymal sperm in azoospermic men when they require PESA-ICSI (percutanesous epididymal sperm aspiration with intracytoplasmic sperm injection.)

To date, most urologists in the United States continue to use an operating microscope to recover epididymal sperm. This is called MESA - micro-epididymal sperm aspiration, ; it is a very time consuming and expensive procedure that involves anesthesia and cutting open the scrotum.

PESA- the process

Most men are understandably quite scared of allowing a surgeon near their testes - and even a testis biopsy can be a very painful experience! However PESA is a very simple technique that allows us to extract epdidiymal sperm, without having to make a skin incision! Its very easy for the patient and less traumatic too – this means, in case it has to be repeated, it can be done without any hassle. Local anesthesia is used in this procedure.  This is the PESA process:

  • The testis is stabilised by stretching the skin tightly over it
  • The turgid and full epididymis is palpated and identified
  • A very fine needle mounted on a tuberculin syringe filled with culture medium is inserted into the dilated epdidymal tubules through the taut skin
  • Negative pressure is applied to aspirate the epididymal contents
  • The needle is pulled out and the syringe withdrawn. This is then sent to the adjoining IVF lab for microscopic examination
  • The contents are expelled into a sterile petri dish
  • The culture medium containing the epdidymal fluid is then examined under an inverted microscope; and motile epdidymal sperm identified and used for ICSI after processing them

Not happy with the attention you are getting from your IVF clinic? Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you!


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