Obstructive or non-obstructive azoospermia?
Both TESA and TESE have critical differences in the procedure that couples must understand. The type of procedure recommended by the fertility clinic depends on the type of azoospermia. Some men have obstructive azoospermia. Sperm is present in the testes, but there is a blockage due to injury, vasectomy, varicocele, cysts, or infections. With non-obstructive azoospermia, there is no blockage. The testes fail to create sperm due to genetic or hormonal reasons.
Time for TESA
Testicular sperm aspiration (TESA) works well for obstructive azoospermia. The procedure uses a long, thin needle to extract or aspirate the sample with negative pressure. TESA happens at the fertility clinic under local anesthesia. The lab then examines the sample under a microscope. If sperm is present, the doctor or medical personnel may take other samples. The sperm is then extracted from the sample for intracytoplasmic sperm injection (ICSI) or IVF.
Surgical extraction with TESE
Testicular sperm extraction (TESE) is a more detailed form of surgical extraction. TESE is a biopsy of testicular tissue to locate healthy sperm. Before TESE, some men may need hormone medication to increase the chances of a viable sample. The medical team will also perform tissue mapping to help find the best sample. The biopsy happens under general anesthesia, with the doctor using small tools to remove testicular tissue. Sperm samples are then extracted for the IVF process.
Pros and cons
Both TESA and TESE have benefits and risks discussed with the patient in advance. TESA is non-surgical and has minimal downtime. TESE is more invasive, detailed, and has a longer recovery. However, TESE may provide a more accurate sample. TESE is also helpful if TESA fails to produce any sperm. Both procedures have side effects like pain, swelling, and discomfort, which should resolve in a few days.
A brighter future
Studies show that both techniques can extract viable sperm for the IVF or ICSI process. With TESE, the downtime is slightly longer but can lead to higher extraction rates. Even with one sperm, ICSI has similar fertilization, implantation, and pregnancy rates as IVF. An azoospermia diagnosis does not mean men have no chance to have biological children. With these advanced procedures, men can hope to finally overcome infertility.