Surgical Sperm Retrieval (PESA, MESA, TESE)
This is a daycare minor surgery done to collect sperm from the vas deferens, epididymis or testis. Sedation or general anaesthesia is required for the procedure. Surgical sperm retrieval may help those who are able to produce sperm but the sperm cannot enter and join the semen due to blockage of vas deferens or epididymis. Surgical retrieved sperm are immature and incapable to fertilise the eggs through conventional means. Thus, sperm that are retrieved surgically will be used together with ICSI to achieve fertilisation.
There are three types of surgical sperm retrieval, namely percutaneous sperm aspiration (PESA), micro-epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE). Option for the treatment will depend on individual condition.
PESA is usually the first option to be used for azoospermia patients. The procedure is relatively short in duration, simple and painless procedure as it does not require surgical incision. In PESA, a fine needle is inserted into the epididymis through the scrotum and fluid is gently aspirated from the epididymis. The procedure is done under local anaesthesia. This fluid obtained is then analyzed for sperm content and motility. The sperm cells retrieved from PESA will be used for ICSI.
MESA is a microsurgical treatment where a small cut is made through the scrotum and into the epididymis. General anaesthesia is required. The fluid collected is then examined for sperm. This is a more invasive method compares to PESA, but the sperm recovery rates are relatively higher. If no sperm is found in the epididymal fluid, the next option is TESE.
TESE involves testicular biopsy (small surgical incision in the testis). A small cut is made into the testis and a small sample of testis is removed, which is then examined for sperm. This procedure requires general anaesthesia and will cause some pain and soreness for a few days.