PESA (Percutaneous Epididymal Sperm Aspiration)
Percutaneous Epididymal Sperm Aspiration (PESA)
PESA is a simple technique to obtain sperm for Intra Cytoplasmic Sperm Injection (ICSI) in men who have an obstruction of the vas deferens, either due to vasectomy or other obstruction. PESA involves aspiration of sperm from the epididymis with a fine needle, through the skin without opening the testicle. To minimize scarring and damage, PESA usually is attempted on one side only. It is sometimes necessary to aspirate from both sides. Sufficient sperm for ICSI is obtained in 80% of attempts. In 10% of cases we can also find enough suitable sperm for cryopreservation.
The procedure is performed in the operating room of an IVF Centre. After the procedure the man will be asked to wear a very tight pair of underpants to provide support to the scrotum. There is no other special preparation for the patient.
PESA is performed under local anesthesia. This means that an anesthetic is injected into the scrotum by the specialist to make the area numb. When this has been achieved the doctor will swab the scrotum with a warm antiseptic. The doctor will examine the testes to locate the vas deferens by gently feeling the scrotum. A small needle will be inserted through the skin into the vas deferens and the doctor will instruct the nurse assisting to draw back the syringe in order to aspirate seminal fluid. When fluid is obtained it is passed to the embryologist to be examined for motile (moving) sperm. The procedure may need to be attempted again until motile sperm have been found.
The procedure is usually performed just prior to the woman’s oocyte collection (on the same day). And sperm donation back up will be prepared by the IVF center in case the couple asked for it.
You have the following options in case good sperm is not found by PESA:
1. IVF egg (oocyte) retrieval might be cancelled if the doctor sees no harm in cancelling the egg retrieval, or the egg retrieval will be done without fertilization, then the eggs they will be destroyed.
2. Eggs retrieved can be frozen for later use.
3. Fertilize the eggs by sperm donation.