Testicular biopsy and aspiration

TESA can be used as a diagnostic procedure to detect azoospermia (a condition whereby a man has no sperm in his seminal fluid), or as a procedure to recover sperm from the testicles of men with obstructions or ejaculatory problems that cannot be treated by any other methods.

In the TESA procedure, a very fine needle is passed into the testicles under anaesthetic, and a tiny amount of material is removed from the seminiferous tubules (network of tiny tubes where sperm are produced). These tubules are then processed in the laboratory and checked for the presence of sperm, which can be either used to fertilise eggs or frozen.

Sperm retrieved from the seminiferous tubules in a TESA procedure are less mature and less motile than sperm found in ejaculated seminal fluid. As such, Intracytoplasmic Sperm Injection (ICSI) – a specialised form of In Vitro Fertilisation (IVF) – is required to achieve fertilisation with TESA sperm.

PESA is done under local or general anaesthetic, with the specialist inserting into the epididymis (the tiny collecting tubules next to the testicles) a needle attached to a syringe, then gently aspirating fluid. The epididymis is the structure into which the sperm first flow after developing and leaving the testicles.

PESA is used for men who have had a vasectomy and for those who have a congenital or acquired genital tract obstruction such as the absence of the vas deferens. The sperm retrieved with this technique can only be used in conjunction with ICSI treatment.

Sperm may not always be obtained with the PESA technique and the specialist may have to perform an open procedure.

An open testicular biopsy is an operative procedure used to obtain sperm by opening the scrotum and surgically removing some seminiferous tubules from the testicle.

The procedure, performed under general anaesthetic, is used for men who have had a vasectomy and for those who have a congenital or acquired genital tract obstruction such as the absence of the vas deferens.

This technique is often performed when TESA has been unsuccessful. Sperm obtained in an open testicular biopsy can only be used with ICSI treatment.

Vibrostimulation is a procedure in which a special vibrator is applied directly to the penis to produce an ejaculation. Electroejaculation is a procedure whereby a special probe is inserted into the rectum to stimulate the pelvic nerves and cause ejaculation.

Men with spinal cord injuries, neurological disorders and ejaculation problems can usually have vibrostimulation or electroejaculation procedures to retrieve sperm. The sperm can sometimes be used for artificial insemination but due to low sperm numbers, the samples can usually be used only for IVF or ICSI.

Men should be aware that some of these treatments carry risks comparable to those of elective surgery. We encourage you to discuss these risks with your treating specialist.