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TESA is a simple technique by which doctors can extract sperm from the testes. Its partly because it's so simple, that it's often been abused, misused and overused.
Thus, many doctors will do TESA unnecessarily , and extract sperm directly from the testes, even in men who have sperm in the semen sample. Not only is this cruel, it also adds needlessly to their expense without improving the pregnancy rate ! They use all kinds of pretext to justify this TESE ( for example, by claiming that the sperm will be fresher or will have lesser DNA fragmentation, but this is rubbish !). The reality is they do this only so they can charge more money, but this is completely uncalled for ! TESA should only be used for patients with azoospermia.

Secondly, a lot of doctors don't do the TESA properly , because they don't know how to do the procedure properly. Many urologists will still do an open biopsy, which is painful and unkind. Gynecologists dont have the necessary expertise, and will often make only half-hearted attempts to suck out sperm from the testes. They end up doing only a fine needle aspiration, and then because they havent sampled the tissue properly, its misreported as "no sperms are found". This can be misleading, because you actually need to take multiple samples properly and suck out testicular tissue in order to examine the entire testes. If this is not done properly, patients can be misled and made to use donor sperm, and this can be unfortunate.


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Source : https://blog.drmalpani.com/2020/05/the-two-major-problems-with-tesa.html
Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.
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