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What is TESA (Testicular Sperm Aspiration) in IVF?

9 fertility expert(s) answered this question

Answer from: Raúl Olivares, MD

Gynaecologist, Medical Director & Owner Barcelona IVF
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TESA stands for Testicular Sperm Aspiration, and it works by inserting a very thin needle in different parts of testicles depending on the case. We may get the sperm from epididymides or directly from testicles, and then with a gentle aspiration, you get a part of this tissue, and you send this aspiration to the laboratory where they can identify sperm.

It is usually done if there is azoospermia, either obstructive, for example, in cases of a vasectomy or when there are a vasa deferens agenesia or in cases of secretory azoospermia and the testicles do not produce any sperm, and we can only get it from the testicle.

It must be said that in cases of secretory azoospermia, the aspiration tends not to be very efficient. It is really difficult to obtain sperm just with aspiration, and we may need to do a biopsy.

Answer from: Sibte Hassan, MBBS, FCPS, MRCOG, MSc

Gynaecologist, Fertility specialist and Gynaecologist at London Womens Clinic
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TESA is Testicular Sperm Aspiration, so rather than opening the testicle or incision on the testicle. It is the least invasive method of surgical sperm retrieval. Under local anesthetic we put the needle within the testicular tissue or if there is an element of obstruction, with a common example of that being cystic fibrosis: a genetic disorder where the tube that transports sperm from the testicle to the outside is missing, so the testes are producing sperm but they are not coming out; we insert it into the remnant of a tubule that is usually swollen and full of sperm so we can get the sperm from that site. It is the least invasive procedure, usually under local anesthetic where we insert the needle through the skin and try to aspirate the sperms if they are there.

Answer from: Alexia Chatziparasidou,  MSc, PMI-RMP

Embryologist, Consultant Clinical Embryologist, Director of Embryolab Academy, Co-Founder of Embryolab Fertility Clinic Embryolab Fertility Clinic
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Testicular sperm aspiration is an intervention in the form of puncturing the testicles and in an effort to retrieve testicular spermatozoa from them. Normally this technique is a good option for men suffering from non-obstructive azoospermia where we are confident that this man, this patient has a good level of spermatogenesis in the testicles. In those cases, we can retrieve enough spermatozoa and use them as fresh that same day of egg collection for micromanipulation and as these spermatozoa normally in most cases are of good quality and functionality, they provide us a good chance for fertilization and implantation. While for the next question, medical definition of TESA involves an intervention, it’s the puncturing of the testicles in an effort to retrieve spermatozoa directly from the testicles and it is used when we need to proceed to fertilization with the form of micromanipulation for most of the cases for azoospermic men suffering from non-obstructing azoospermia. In selected cases, we may provide this option for men that have good numbers and good sperm count but they have been diagnosed with high DNA fragmentation index and for these men TESA will give us an option to retrieve testicular spermatozoa with better structure of DNA.

Answer from: Kevin McEleny, BSc(Hons), BM, FRCS(Eng), FRCS (Ed), FRCS(Urol), PhD

Urologist, Male fertility specialist, Urologist at Newcastle Fertility Centre
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TESA stands for Testicular Sperm Aspiration and in a TESA what you’re trying to do is to recover sperm directly from the testicle using a needle. So the person carrying it out will inject local anaesthetic into the scrotum (that’s what it is called) when this happens numb, they put a fine needle in and they pour out a sample which will hopefully contain sperms. It’s a reasonable technique for obstructive azoospermia but not so good for non-obstructive azoospermia.

Answer from: Yacoub Khalaf, Professor

Gynaecologist, Professor of Reproductive Medicine and Surgery at King’s College
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TESA in IVF refers to the way the sperm is extracted directly from the testicle and that when the production of sperm is a little bit less than it should be so much so that it’s not enough to appear in the ejaculate but still there is evidence that there is sperm in the testes or sometimes, it’s used when there is obstruction, so the distribution system is blocked. So you go directly to either to the body of the so-called epididymis where the sperm is stored and occasionally the epididymis is fibrotic, you go directly with a needle into the body of the testes and suck out a few sperms.

Answer from: Alessandra Parrella

Embryologist, Andrologist, Embriologist IVF-Spain
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TESA or Testicular Sperm Aspiration is a simple procedure used to obtain sperm in man who are not making enough spermatozoa or in man who despite the correct production, there are not enough spermatozoa in ejaculate because the blockage prevent them from reaching the semen. During this procedure, the needle is inserted in the testes and tissue containing spermatozoa are aspirated. It is done with local anesthesia in the operating room and usually at the same day of the egg retrieval. The overleft sample not utilised during the ICSI procedure can be frozen for the future treatment.

Answer from: Eugenia Rocafort, BSc, MSc

Embryologist, Senior Embryologist ESHRE and ASEBIR certified Quironsalud Hospital Barcelona
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We have to take into account that when we perform a TESA, we will have a lower sperm sample than when we perform TESE. Usually when we perform TESA, we are sure that we will find sperm sample like when we have an obstructive azoospermia like vasectomy that we will have for sure sperm and we just need a few samples.

Answer from: Aleksandr Darii, PhD

Gynaecologist, Leading Fertility Specialist at ICSI Clinic ICSI Clinic
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TESA is a procedure used to obtain sperm in male infertility. It is a testicular biopsy where a small needle is inserted into the front of the organ to collect the semen and a small piece of tissue. Motile, healthy spermatozoa are found in the extracted material and then they can be used for IVF.

The procedure is performed under intravenous anaesthesia, so a thin needle is inserted through the skin of the scrotum. After taking several tissue samples from the epididymis, they are placed in a special environment where the embryologist separates the sperm from other tissues.

If the testicular biopsy test is performed simultaneously as the women’s ovarian puncture in an IVF cycle, the sperm can be immediately used to fertilise eggs using ICSI. The resulting embryos are transferred, after a few days, into the women’s uterus, where they are implanted, and pregnancy begins to develop.

If the testicular biopsy (TESA) is performed outside of the IVF cycle, the sperm can be frozen for future use in the IVF cycle. If the TESA is successful and enough functional sperm is collected, the cells can be injected into the egg’s membrane within 72 hours. In addition, sperm can be frozen, which helps avoid a second biopsy as a first and favourable outcome of IVF or ICSI.

Also, this is a very recent practice. Its performance indicators are very high if early diagnosis of azoospermia meant 100% infertility of men. Now, with the help of semen collection and injection into the egg, the number of people who have experienced the joys of fatherhood has increased.

Answer from: Andris Abele, MD

Andrologist EGV Clinic
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Medical term TESA means testicular sperm aspiration. It is done with local or intravenous anesthesia in the operating room or office and is coordinated with the egg retrieval of the patient’s female partner. A needle is inserted into the testicle and tissue containing sperm is aspirated. Aspirated sperm, later on, is used for in vitro fertilization procedure, which is a type of assistive reproductive technology. TESA is usually performed for men with obstructive azoospermia – a condition when semen contains no sperm due to male reproductive system obstruction, for example, after vasectomy.

About this question:

What is a medical definition of TESA and how it is used in IVF?

TESA is performed with a needle, which is inserted in the testicle to obtain sperm for IVF/ICSI treatment. How exactly does it work? When is it indicated?

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