Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is used to retrieve sperm from men with infertility issues. It is particularly effective for those with obstructive azoospermia, where sperm is missing due to a blockage. The procedure extracts sperm directly from the epididymis.

What is PESA?
What Is the Purpose of Using PESA?
How is PESA Performed?
Things to Remember for PESA
FAQ'S

What is PESA?

Percutaneous Epididymal Sperm Aspiration (PESA) is the least invasive sperm retrieval technique. It retrieves sperm directly from the epididymis, the tube on top of the testicle where sperm matures. PESA helps men who produce sperm, but have a blockage that prevents ejaculation.

Indications for PESA

PESA is particularly useful for men with obstructive azoospermia.
In this condition, sperm production is normal, but a blockage prevents sperm release during ejaculation.
This blockage can be due to congenital absence of the vas deferens, prior vasectomy, or scarring from infections or surgeries.

PESA offers an effective and less invasive option for sperm retrieval, providing hope for men with fertility challenges.

What Is the Purpose of Using PESA?

PESA is primarily performed to retrieve sperm directly from the epididymis in men. The key reasons why PESA is done include:

Obstructive Azoospermia: PESA helps retrieve sperm when a blockage prevents ejaculation despite normal sperm production.
Facilitating IVF/ICSI: Sperm retrieved through PESA can be used in fertility treatments. This includes in vitro fertilisation (IVF) with intracytoplasmic sperm injection (ICSI).
Minimally Invasive Approach: PESA is a less complex and minimally invasive procedure compared to other sperm retrieval methods.
Higher Success Rates: When combined with IVF/ICSI, PESA has high success rates in achieving pregnancy, especially in obstructive azoospermia cases.

How is PESA Performed?

PESA is typically used in cases where there are difficulties with sperm production or ejaculation. Here’s an overview of how PESA is performed:

Preparation

Consultation: The patient meets with a fertility specialist to discuss the process, indications, and any potential risks.
Pre-procedure testing: Blood tests and imaging studies may be conducted to assess overall health.
Anaesthesia: The procedure is usually done with local anaesthesia to reduce discomfort.

Procedural Steps

Positioning: The patient lies down comfortably.
Skin preparation: The scrotum area is cleaned and sterilised to prevent infection.
Needle insertion: A thin needle is inserted through the scrotum into the epididymis.
Sperm aspiration: Fluid is drawn out from the epididymis.
Sample evaluation: The fluid is examined under a microscope. If viable sperm are not found, the doctor may recommend advanced techniques like TESA or Micro-TESE.

Post-Procedure Care

Recovery: The patient is watched for a little while to check for any immediate complications after the procedure.
Post-procedure Instructions: Patients should wear supportive underwear.
Sperm Use: The retrieved sperm can be used right away for fertility treatments or frozen for later.
Follow-Up: A follow-up visit may be needed to review the sperm analysis results.

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Things to Remember for PESA

Before the Treatment

Meet with a fertility specialist to discuss options and expectations.
Complete any required medical tests to confirm suitability.
Learn about the PESA process, including risks and benefits.
Make necessary lifestyle changes, like quitting smoking or adjusting medications
Mentally prepare for the procedure and possible outcomes.
Discuss anaesthesia options with your doctor.

During the Treatment

During and after the PESA procedure, several key steps are important for both the patient and the healthcare team:
The patient is positioned comfortably.
The scrotum area is cleaned and sterilised to prevent infection.
A thin needle is inserted into the epididymis through the scrotum.
Fluid-containing sperm is drawn out from the epididymis.
The fluid is examined in the lab for viable sperm.

After the Treatment

The patient is monitored in a recovery area as the anaesthesia wears off.
Nurses look for complications such as bleeding or signs of infection and assess comfort.
If stable and the procedure is outpatient, the patient may be discharged on the same day.
Watch for signs of complications like increased pain, swelling, fever, or unusual discharge and contact the healthcare provider if these occur.
Generally, post-procedure Instructions are that the patient should wear supportive and compressed underwear to avoid any complications.
Sperm Use: The retrieved sperm can be used right away for fertility treatments or frozen for later.
Follow-Up: A follow-up visit may be needed to review the sperm analysis results.

Frequently Asked Questions

The number of viable sperm present in the fluid aspirated from the epididymis is generally too low for conventional IVF treatments and ICSI is recommended when sperm is retrieved surgically.

PESA is performed under local anaesthesia. The scrotum is numbed before the needle aspiration is done, and the patient will not experience any pain during the procedure.

PESA is a minimally invasive procedure that requires no hospitalisation. Patients can get back to their normal routine within 24 hours of the procedure.

Azoospermia or absence of sperm in semen can be caused by genetic issues like congenital absence of the vas deferens. It can also be the result of infections including sexually transmitted infections and certain medical treatments like cancer treatments.

There is no evidence which suggests lowered chances of conception with the use of surgically retrieved sperm or an increased risk of congenital issues in children conceived with the retrieved sperm either.

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We came in for a fallopian tube test, expecting to be recommended IVF. However, our doctor at Birla Fertility & IVF suggested a minor treatment and provided exceptional support and guidance. Thanks to this thoughtful approach, we conceived naturally. We are deeply grateful to the team at Birla Fertility & IVF for their care. With the right support, you’ll be well taken care of. Trust the process and go with the flow!

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Success after multiple IVF failures

Doctor’s expertise turned our parenthood dream into reality

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