PESA - non-surgical epididymal sperm aspiration for treating obstructive azoospermia

The best treatment choice for the man with obstructive azoospermia (zero sperm count because of a block in the reproductive tract) is percutaneous epididymal sperm extraction (PESA) with ICSI (intracytoplasmic sperm injection) in which epididymal sperm are injected into the eggs in order to fertilise them. Here is a photo-essay which describes the painless technique we use in our clinic for extracting epdidiymal sperm in azoospermic men when they need PESA-ICSI (percutanesous epididymal sperm aspiration with intracytoplasmic sperm injection.)

In the US, most urologists still use an operating microscope to recover epididymal sperm. This is called MESA - micro-epididymal sperm aspiration, which is very expensive and very time consuming. It also involves anesthesia and cutting open the scrotum.

Most men are understandably scared of allowing a surgeon near their testes - and even a testis biopsy can be a very painful experience! This simple technique allows us to extract epdidiymal sperm, without even having to make a skin incision!

Not only is this much easier for the patient, it also much less traumatic, which means it can be repeated if needed. It is usually done under local anesthesia.

The success rate with PESA-ICSI is excellent !

1. The testis is stabilised by stretching the skin tightly over it.
2. The turgid and full epididymis is palpated and identified
3. A very fine needle mounted on a tuberculin syringe filled with culture medium is inserted into the dilated epdidymal tubules through the taut skin.
4. Negative pressure is applied to aspirate the epididymal contents .
5. The needle is pulled out and the syringe withdrawn. This is then sent to the adjoining IVF lab for microscopic examination
6. The contents are expelled into a sterile petri dish
7. 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
Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.