NEWS & KNOWLEDGE

A surgical procedure to extract sperm from epididymis can be done when men have the following abnormalities:

• Sperm cannot be found in the fluid due to blockages in vas deferens, or there is no vas deferens since birth.
• Not being able to store sperm with natural methods.
• Not being able to ejaculate sperm normally, or having a problem to do so because of other health problems. All the sperm that come out are not alive.
• Those who have been done a vasectomy and do not want to have a reversal.

In the past, men who had been diagnosed with infertility were unable to have children unless they received donated sperm.

However, with advanced technology, doctors can perform a procedure that retrieves healthy sperm directly from the source which is the epididymis or testis. The doctor will examine an appropriate method of surgery according to the condition of each patient.  

These are the steps of the procedure:
PESA (Percutaneous Epididymal Sperm Aspiration)

PESA is a surgical procedure that requires a small needle with a radius of 2 millimeters to extract sperm from the epididymis. The epididymis is on the top part of the testicles which is where sperm is. After retrieving the fluid, the doctor will examine, look for sperm, evaluate the quality, and use it for ICSI procedures.

PESA usually takes about 10-20 minutes, and the patient will be given local anesthesia before the procedure. The patient should rest for an hour after the procedure is done then he can go home.

TESE (Testicular Sperm Extraction)

This method is used after trying to retrieve sperm but cannot find sperm in the epididymis. The doctor will use a small blade to trim the skin that covers the testicles. The cut is not more than 1-2 millimeters. The doctor will bring the tissue that produces sperm in order to examine for sperm. Local anesthesia will be given, and it will be a bit painful. Therefore, painkiller medicine might be given, and all the pain will be gone within 3 days.

Guidelines before the procedure
The doctor will require a blood test to evaluate overall health and to prepare for the surgery. The patient must refrain from eating and drinking 6-8 hours before the procedure.

Guidelines after the procedure

1. Keep the wound dry and avoid swimming or being in a bathtub until the wound is completely dry and healed.
2. After using the toilet, make sure to wipe the wound dry and always keep it clean and dry. 
3. Take painkiller medication and antibiotics according to the doctor’s prescription to reduce swollen and avoid inflammation.
4. Avoid doing exercises for 2 weeks to avoid pain and inflammation.
5. Refrain from having sexual intercourse until the wound is completely dry and healed. 

Risks and side effects of the procedure

We only found less than 2% that had an infection, blood clots in the testicles, and pain after the surgery. However, these can be treated and go back to normal.

The Success of this treatment

The TESE procedure is very successful, especially in patients with blockage in vas deferens. However, the success rate also depends on the causes of each individual.

Are PESA/TESE safe procedures?

In general, they are very safe procedures, and they offer better options for patients with infertility. From a current study, the rates of having abnormalities and disabilities in babies from doing the procedures are not different from normal cases.

By Assoc.Prof. Matchuporn Sukprasert