What is the difference between TESA and TESE?

TESA procedure stands for Testicular Sperm Aspiration and TESE stands for Testicular Sperm Extraction and the differences are the way we are going to get the sperm.

When we’re doing TESA, we’re going to insert a thin needle either into the epididymis or the testicles. We’re going to gently aspirate and obtain sperm from that.

When we’re doing TESE, we need to surgically open the testicle and remove a part of the tissue and the lab is going to identify the sperm in that portion of tissue.

In general, we can see that TESA can be done when we think that the chances of obtaining sperm are higher, it is a less invasive procedure, which is usually better tolerated. With the right protocol of painkillers having a TESA should be easy and the patient can start leading a normal life in 24-48 hours after the procedure.

TESA or TESE can be done for men who would follow two different categories so you have obstructive azoospermia so that’s no sperm in the ejaculate and obstruction can be because of something like cystic fibrosis and the testicles have no way of getting the sperm out into the ejaculate or they’ve had vasectomy and it’s just a case of doing a PESA where needles placed into the epididymis and aspirated. Generally it’s quite straightforward, they’re very easy to do. You can have non-obstructive azoospermia which is more difficult to get sperm from, so that could be to do something with a hormonal problem so if you’re FSH which is what causes your testicles to produce sperm, if that’s quite high, it can actually shut your testicles off and from producing sperm – so there’s no sperm in your ejaculate and the higher the FSH gets, the less chance of finding sperm and so instead of going into the epididymis, you’ll do various needle sites into the various places in the testicles to try and aspirate bits of tissue. The tissue goes into the lab and we sort of process it and try and find sperm that way and it’s less successful because you’re not necessarily producing sperm and whereas in obstructive azoospermia you in most cases producing sperm and it’s just a storage issue, it just can’t escape so you just go straight to the source and extract it.

Men who have no sperm in their ejaculate (we call this azoospermia) can be due to different causes. So their option is to have surgical sperm retrieval, we perform an operation of the testicles and there are three ways of doing this. One is a less invasive method and we call it TESA- Testicular Sperm Aspiration and the other method is TESE where we slightly open the testicles but without the microscope and a tiny tissue that we give to the lab and they see whether there are sperms inside the testicle tissue or not.

The testicular sperm aspiration or TESA is a method where the sperm cells, if they are missing in the ejaculate but there’s still a chance that there might be in the testes, are obtained directly from the testes via a fine needle aspiration. An alternative to this and perhaps a slightly stronger or successful, more successful alternative is the TESE method – the testicular sperm extraction where actually small biopsies of the tissue, small pieces of the tissue from the testes are collected during the surgery and then they’re worked with in the lab to provide actually the sperm cells. These sperm cells are looked for and extracted from this tissue so sometimes even in a situation where the ejaculate itself carries no sperm cells, we are able to get these directly from the testes and fertilize the eggs of the partner of the woman with the man’s sperm cells successfully.

Both of the techniques are very important techniques when it comes to the treatment of azoospermic patients. Both of them involve the retrieval of testicular spermatozoa directly from the testicles. In case of TESA it involves aspiration so, it’s a sore procedure which is performed under mild anesthesia and during which the testicles are punctured by an expert urologist or andrologist and a few, a limited number of spermatozoa are directly aspirated and retrieved and checked under the microscope. In some cases, the expert, the operator may need to proceed to a second or more punctures until enough spermatoza are retrieved. In case of a TESE, it’s more a kind of operation where there is a biopsy, the testicles are biopsied but again by an operator and under anesthesia and during this operation (which may take quite a longer period that’s let’s say half an hour or more), testicular tissues, tissue pieces are retrieved and normally these tissue pieces are checked for the presence of spermatozoa and again, the operator may need to retrieve more than few testicular tissue until enough spermatozoa are retrieved for fertilization purposes or even for storage purposes in the form of testicular tissue and spermatozoa cryopreservation.

A TESA what happens is the doctor or person counting the procedure will inject the scrotum and then when it’s numb they’ll put a needle into the testicle to draw out fluid with a syringe. In a TESE (Testicular Sperm Extraction) rather than aspiration what will happen is that the person doing, will make a little nick in the skin and to that nick cut into the testicle directly and nip a little bit of the testicle away as a biopsy to extract sperm direct from the testicle rather than drawing out with a needle. It’s a little bit more invasive but perhaps might give more sperm according to some sources.

TESA is aspiration where you use a needle but TESE is where you make a cut and try to take a biopsy which is a piece of testicle effectively. Don’t worry it is a tiny one and give it to the embryologists who will mince it and filter it and take any sperm that they can find under a microscope.

TESE (Testicular Sperm Extraction) and TESA (Testicular Sperm Aspiration) are techniques used to retrieve the spermatozoa when they are not found in the ejaculate. TESE is a surgical biopsy that is carried out making small incisions of the testes to remove testicular tubules that are examined for the presence of the spermatozoa under the microscope. TESA is performed by inserting the needle in the testicle and aspirating fluid and tissue containing spermatozoa. Both procedures are performed with local anesthesia in the operating room. They are either done as scheduled procedure or coordinated with female partner egg retrieval.

As the name says,  TESA is Testicular Aspiration and TESE is Testicular Extraction meaning we need to do a biopsy from the testicle. However, with TESA we go with the needle to “aspirate” some tubulos from the testicle. It will depend on the Andrologist which procedure is better for you since every procedure has it’s pros and cons.

There are acronyms for different ways of getting sperm out of the testes during the process onto surgical sperm retrieval. TESA is testicular sperm aspiration that is where a needle, a very large bore needle is injected into the testes and then the testicular tissue is aspirated from the testes and then the sperm is extracted from that testicular aspiration. TESE is more invasive, it tends to be more pieces of testicular tissue extracted. It’s cut from the testes and then put into a little dish in the labs and then, the sperm is extracted from that. Both of them are invasive, both of them require a removal of testicular tissue and it comes to risks of infections and loss of testicular tissue but both of them can recover sperm from men who have obstructive azoospermia (that is they’re not producing any sperm) or non-obstructive azoospermia in the semen sample. Both are invasive methods of surgical sperm retrieval for extracting sperm for men who don’t produce sperm in their sample.

The difference is within the technique of sperm retrieval. TESA or testicular sperm aspiration is performed by sticking a needle in the testis and aspirating fluid and tissue with negative pressure – this means that the physician obtains a small sample of tissue using gentle suction. While TESE or testicular sperm extraction is actually a surgical biopsy of the testis to retrieve tissue that contains sperm – this means that a small piece of testicular tissue is resected from one or both testes.